Healthcare Provider Details

I. General information

NPI: 1255390753
Provider Name (Legal Business Name): DAVID C BRILLIOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOSPITAL LN
CALAIS ME
04619-1329
US

IV. Provider business mailing address

270 SHATTUCK RD
CALAIS ME
04619-4306
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax: 207-454-3616
Mailing address:
  • Phone: 207-454-0173
  • Fax: 207-454-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number021982
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: