Healthcare Provider Details

I. General information

NPI: 1083116743
Provider Name (Legal Business Name): THERESE B BRILLIANDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EXECUTIVE DR
GREER SC
29651-1244
US

IV. Provider business mailing address

20 POWDERHORN RD
SIMPSONVILLE SC
29681-3399
US

V. Phone/Fax

Practice location:
  • Phone: 864-879-2111
  • Fax:
Mailing address:
  • Phone: 864-963-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number242794
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: