Individual
MARIE COLLINS CUSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
SFA ATHLETIC FIELDHOUSE 712 HAYTER ST, NACOGDOCHES, TX 75962-0001
(936) 468-3506
(936) 468-4052
Mailing address
SFA ATHLETIC FIELDHOUSE 712 HAYTER ST, NACOGDOCHES, TX 75962-0001
(936) 468-3506
(936) 468-4052
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT84467
TX
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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