Provider Demographics
NPI:1710321872
Name:PFISTER, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
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 1:12212 85TH AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3318
Mailing Address - Country:US
Mailing Address - Phone:718-459-5592
Mailing Address - Fax:
Practice Address - Street 1:12212 85TH AVE
Practice Address - Street 2:FL 1
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3318
Practice Address - Country:US
Practice Address - Phone:718-459-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662171-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse