Individual
CAROLYN BETH CUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
112 S MAIN ST STE 2A, JEFFERSON, WI 53549-1657
(920) 674-6707
(920) 674-6707
Mailing address
112 S MAIN ST STE 2A, JEFFERSON, WI 53549-1657
(920) 674-6707
(920) 674-6707
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
636-55
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679872576
CMS
WI
Enumeration date
03/18/2011
Last updated
03/13/2020
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