Provider Demographics
NPI:1083116743
Name:BRILLIANDT, THERESE B (RN)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:B
Last Name:BRILLIANDT
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 1:20 POWDERHORN RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3399
Mailing Address - Country:US
Mailing Address - Phone:864-963-3421
Mailing Address - Fax:
Practice Address - Street 1:220 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1244
Practice Address - Country:US
Practice Address - Phone:864-879-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC242794163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health