Provider Demographics
NPI:1467954347
Name:LILLEHEI, BRIANNA JEAN (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:JEAN
Last Name:LILLEHEI
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 GUADALUPE ST APT 208
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3097
Mailing Address - Country:US
Mailing Address - Phone:651-246-2406
Mailing Address - Fax:
Practice Address - Street 1:4525 GUADALUPE ST APT 208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3097
Practice Address - Country:US
Practice Address - Phone:651-246-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135114364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health