Provider Demographics
NPI:1558808642
Name:GARIVAY, BECKY LYNN
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:GARIVAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6472 UPPER 54TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1110
Mailing Address - Country:US
Mailing Address - Phone:651-363-1788
Mailing Address - Fax:
Practice Address - Street 1:6472 UPPER 54TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55128-1110
Practice Address - Country:US
Practice Address - Phone:651-363-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1558808642OtherNPI NUMBER
1558808642OtherNPPES