Provider Demographics
NPI:1295371953
Name:CORRIELL, BRIANA LYNNE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNNE
Last Name:CORRIELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 W 1ST AVE APT F
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1734
Mailing Address - Country:US
Mailing Address - Phone:509-551-4192
Mailing Address - Fax:
Practice Address - Street 1:7514 W YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1101
Practice Address - Country:US
Practice Address - Phone:509-783-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60917855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000000000000000OtherN/A