Healthcare Provider Details

I. General information

NPI: 1285774042
Provider Name (Legal Business Name): BRANDI L PENATZER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI L PARKINSON PA

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 SOMERSET ST
JOHNSTOWN PA
15901
US

IV. Provider business mailing address

337 SOMERSET ST
JOHNSTOWN PA
15901-2541
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-4724
  • Fax:
Mailing address:
  • Phone: 814-534-4724
  • Fax: 412-235-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052554
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA-052554
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA052554
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: