Provider Demographics
NPI:1861419723
Name:GARVEY, CATHERINE M (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:GARVEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:ODLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6029
Mailing Address - Country:US
Mailing Address - Phone:701-280-4600
Mailing Address - Fax:701-280-4620
Practice Address - Street 1:2801 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6029
Practice Address - Country:US
Practice Address - Phone:701-280-4600
Practice Address - Fax:701-280-4620
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0332363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND71096Medicaid
Q50352Medicare UPIN
NDN711506Medicare PIN