Individual
STEPHANIE CARMEN CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 E BROAD ST, BRIDGETON, NJ 08302-2503
(856) 459-2402
Mailing address
1026 FALCON WAY, VINELAND, NJ 08360-4469
(609) 805-6509
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP04816700
NJ
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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