Provider Demographics
NPI:1285774042
Name:PENATZER, BRANDI L (PA)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:L
Last Name:PENATZER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:L
Other - Last Name:PARKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:337 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2541
Mailing Address - Country:US
Mailing Address - Phone:814-534-4724
Mailing Address - Fax:412-235-4012
Practice Address - Street 1:337 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:814-534-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052554207X00000X, 363A00000X
PAMA-052554174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA-052554OtherLICENSE #