Provider Demographics
NPI:1548975410
Name:PUGH, PEARL MARIE (RN)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:MARIE
Last Name:PUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4930 MANSLICK RD APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4089
Mailing Address - Country:US
Mailing Address - Phone:502-491-4692
Mailing Address - Fax:502-491-4693
Practice Address - Street 1:2200 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4014
Practice Address - Country:US
Practice Address - Phone:502-491-4692
Practice Address - Fax:502-491-4693
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1077458163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology