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NPI Code Detail

MEDICARE: BECKY LYNN GARIVAY

MEDICARE:   BECKY LYNN GARIVAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374U00000XHome Health Aide
2171W00000XContractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11558808642OTHERMNNPI NUMBER
21558808642OTHERNPPES

General Provider Information

NPI Number : 1558808642
Entity Type Code : Individual
Provider Name (Legal Business Name) : BECKY LYNN GARIVAY
Provider Business Mailing Address
First Line : 6472 UPPER 54TH ST N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55128-1110
Country : US
Telephone Number : 651-363-1788
Fax Number :
Provider Business Practice Location Address
First Line : 6472 UPPER 54TH ST N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55128-1110
Country : US
Telephone Number : 651-363-1788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2017
Last Update Date : 04/12/2019

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Directions to “ BECKY LYNN GARIVAY ” Practice Location

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