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NPI Code Detail

MEDICARE: DAVID C BRILLIOTT CRNA

MEDICARE:   DAVID C BRILLIOTT  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist021982ME

General Provider Information

NPI Number : 1255390753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID C BRILLIOTT CRNA
Provider Business Mailing Address
First Line : 270 SHATTUCK RD
Second Line :
City : CALAIS
State : ME
Zip : 04619-4306
Country : US
Telephone Number : 207-454-0173
Fax Number : 207-454-3616
Provider Business Practice Location Address
First Line : 22 HOSPITAL LN
Second Line :
City : CALAIS
State : ME
Zip : 04619-1329
Country : US
Telephone Number : 207-454-7521
Fax Number : 207-454-3616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 07/08/2007

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Directions to “ DAVID C BRILLIOTT CRNA” Practice Location

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