Custer, Mary Ann
Custer, Mary Ann is an individual health care provider with primary practice located at 18040 Sw Lower Boones Ferry Rd Suite 100, Tigard OR 97224-7258. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Custer, Mary Ann can be contacted via phone (503) 216-0700.Contact Information
Primary practice address
18040 Sw Lower Boones Ferry Rd Suite 100
Tigard OR 97224-7258
Phone: (503) 216-0700
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 200850006NP | Oregon |
Profile Details
| NPI number | 1891972865 |
|---|---|
| LBN Legal business name | Custer, Mary Ann |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 22nd, 2008 |
| Last updated | Oct 28th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891972865 | NPPES |
| Oregon | MEDICAID | 218626 | |
| Oregon | Other | P00650720 |
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