Provider Demographics
NPI:1609805050
Name:BRILL, GERARD R (CRNA)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:R
Last Name:BRILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KERRY CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-5414
Mailing Address - Country:US
Mailing Address - Phone:814-255-6023
Mailing Address - Fax:
Practice Address - Street 1:3109 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4475
Practice Address - Country:US
Practice Address - Phone:814-696-8886
Practice Address - Fax:814-696-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN333873L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028802Medicare ID - Type Unspecified
PAS84708Medicare UPIN