Provider Demographics
NPI:1023191400
Name:BRISTER, GINGER L (CRNA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:L
Last Name:BRISTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:BRISTER
Other - Last Name:WOODUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:25 COURTENAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-810-8290
Mailing Address - Fax:
Practice Address - Street 1:2095 HENRY TECKLENBURG DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5733
Practice Address - Country:US
Practice Address - Phone:843-876-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC74390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1103Medicaid
SCAN1103Medicaid
SCQ33008Medicare UPIN
SCP00078402Medicare ID - Type UnspecifiedRR MEDICARE