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Individual

MS. ANNA G. CUSTODIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGPCNP-BC

Contact information

Practice address
480 MAIN ST APT 3G, NEW YORK, NY 10044-0406
(845) 521-2887
Mailing address
480 MAIN ST APT 3G, NEW YORK, NY 10044-0406
(845) 521-2887

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
604515
NY
363LP2300X
Primary Care Nurse Practitioner
Primary
F309861-01
NY

Other

Enumeration date
09/16/2020
Last updated
09/16/2020
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