Individual ProviderIvy CusterNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1234 E Dupont Rd Ste 3, Fort Wayne, IN 46825-1545(260) 425-5970PECOS EnrollmentBased on the most recent information from CMS, provider Ivy Custer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:58 AM.Profile DetailsProvider ID1245955095Provider TypeIndividualFull NameCuster, IvyCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date10/4/2022Last Updated3/23/2023Contact InformationPractice LocationPractice Address1234 E Dupont Rd Ste 3, Fort Wayne, IN 46825-1545Phone(260) 425-5970FaxUnlisted FaxMailing LocationMailing Address11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71013312AIndiana