Basic Information
Provider Information
NPI: 1003151796
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIROUX-PFISTER
FirstName: KATHLEEN
MiddleName: MARY
NamePrefix: MS.
NameSuffix:  
Credential: APN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 SURRYSE RD
Address2: SUITE 110
City: LAKE ZURICH
State: IL
PostalCode: 600473217
CountryCode: US
TelephoneNumber: 8478427565
FaxNumber: 8474386756
Practice Location
Address1: 720 GOODLETTE RD N STE 500
Address2:  
City: NAPLES
State: FL
PostalCode: 341025656
CountryCode: US
TelephoneNumber: 2395667676
FaxNumber: 2395669149
Other Information
ProviderEnumerationDate: 12/06/2012
LastUpdateDate: 03/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209.010052ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X9404489FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
2015072029583605IL MEDICAID


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