Provider Demographics
NPI:1013622992
Name:MCGINLEY, BRENDA BOURGER (RD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:BOURGER
Last Name:MCGINLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-1110
Mailing Address - Country:US
Mailing Address - Phone:570-350-0274
Mailing Address - Fax:
Practice Address - Street 1:228 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2545
Practice Address - Country:US
Practice Address - Phone:570-904-7363
Practice Address - Fax:570-348-4079
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered