Provider Demographics
NPI:1467472274
Name:BRIOLAT, GAIL M (ACNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:BRIOLAT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:3535 W 13 MILE RD STE 407
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-0638
Practice Address - Fax:248-551-4491
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGB201708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB9133OtherRAILROAD MEDICARE
MI0F323590OtherBLUE CROSS BLUE SHIELD
MI0F323590OtherBLUE CROSS BLUE SHIELD
CB9133OtherRAILROAD MEDICARE