Provider Demographics
NPI:1508016627
Name:BRILL, AMY ROSE
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROSE
Last Name:BRILL
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 1:11333 N 92ND ST UNIT 2071
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6155
Mailing Address - Country:US
Mailing Address - Phone:602-448-0981
Mailing Address - Fax:
Practice Address - Street 1:11333 N 92ND ST UNIT 2071
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6155
Practice Address - Country:US
Practice Address - Phone:602-448-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPT 6833174400000X
SC4262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist