Healthcare Provider Details

I. General information

NPI: 1477511855
Provider Name (Legal Business Name): ELEANOR THERESA GARAVAGLIA RN MSRC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 OSCEOLA AVE.
KINGSTON PA
18704-5118
US

IV. Provider business mailing address

389 OSCEOLA AVE
KINGSTON PA
18704-5118
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-3521
  • Fax:
Mailing address:
  • Phone: 570-824-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN205740L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: