MEDICARE: BRIANNA JEAN LILLEHEI AGCNS-BC

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
1	364SA2200X	Adult Health Clinical Nurse Specialist	AP135114	TX

General Provider Information

NPI Number	:	1467954347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA JEAN LILLEHEI AGCNS-BC

Provider Business Mailing Address
First Line	:	4525 GUADALUPE ST APT 208
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3097
Country	:	US
Telephone Number	:	651-246-2406
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 GUADALUPE ST APT 208
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3097
Country	:	US
Telephone Number	:	651-246-2406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	09/11/2025

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