Provider Demographics
NPI:1083081632
Name:VODOVOZ, BRIELLE (RN)
Entity Type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:VODOVOZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2243
Mailing Address - Country:US
Mailing Address - Phone:914-414-7442
Mailing Address - Fax:718-987-0033
Practice Address - Street 1:324 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2243
Practice Address - Country:US
Practice Address - Phone:914-414-7442
Practice Address - Fax:718-987-0033
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY699586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse