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General NPI Number Information
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NPI Number | 1285877399
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Entity Type | Individual
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Provider Name | BRENDA ANN PAVILL FNP, PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 37 WILLIAMS ST THE CARE AND CONCERN FREE CLINIC
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City | PITTSTON
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State | PA
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Zip | 18640
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Country | US
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Telephone | 570-954-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 GATES RD
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City | SHAVERTOWN
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State | PA
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Zip | 18708-9595
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Country | US
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Telephone | 570-406-3743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP009746
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License Number State | PA
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