Provider Demographics
NPI:1316647373
Name:CUSTER, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12491 CEDAR RD APT 5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3276
Mailing Address - Country:US
Mailing Address - Phone:330-968-5108
Mailing Address - Fax:
Practice Address - Street 1:35015 MILES RD
Practice Address - Street 2:
Practice Address - City:MORELAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44022-2359
Practice Address - Country:US
Practice Address - Phone:216-577-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker