Provider Demographics
NPI:1942428222
Name:PHISTER, MARGARET V (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:V
Last Name:PHISTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:V
Other - Last Name:RATHBUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13939 ROCKY GAP LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8615
Mailing Address - Country:US
Mailing Address - Phone:908-963-8413
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-384-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08390200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087174Medicare PIN