Individual
LISA M CUSTEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1430 WILKINS CIR, CASPER, WY 82601-1336
(307) 237-9583
Mailing address
1430 WILKINS CIR, CASPER, WY 82601-1336
(307) 237-9583
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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