Provider Demographics
NPI:1093944175
Name:PFISTER, CHARMAINE GILB
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:GILB
Last Name:PFISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-276-5454
Mailing Address - Fax:859-277-1961
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-276-5454
Practice Address - Fax:859-277-1961
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1028802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily