=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821560871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIONNA EMILY LYLES LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2018
-----------------------------------------------------
Last Update Date | 12/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 WILBUR COURT
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-717-1760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 GLENBROOK RD
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-2966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-273-1936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 41518
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------