| Doctor Name: | BETSY CUSTARD |
| NPI Number: | 1164666236 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 12586 |
| Business Practice Address: | 3484 N Constance Dr. Prescott Valley, AZ - 86314 |
| Business Phone Number: | 9284431991 |
| Business Fax Number: | |
| Mailing Address: | 440 N Washington Ave, PRESCOTT |
| State: | AZ |
| Postal Code: | 863012642 |
| Phone Number: | 9284431991 |
| Fax Number: | 9287712351 |
| NPI Enumeration Date: | 04/21/2009 |
| NPI Last Update Date: | 04/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 177F00000X |
| License Number: | 12586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Lodging |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |