Healthcare Provider Details

I. General information

NPI: 1912362807
Provider Name (Legal Business Name): BRENDA LEE MCGARVEY BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA LEE DINGER BS

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALDWELL DR
DU BOIS PA
15801-1152
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY N
INDIANA PA
15701-1372
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1100
  • Fax: 814-375-0120
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: