Provider Demographics
NPI:1609912179
Name:BRILL, TONYA MAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MAE
Last Name:BRILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:12122 MINERAL STREET
Mailing Address - City:BUFFALO
Mailing Address - State:OH
Mailing Address - Zip Code:43722-0074
Mailing Address - Country:US
Mailing Address - Phone:740-685-8786
Mailing Address - Fax:
Practice Address - Street 1:12122 MINERAL STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:OH
Practice Address - Zip Code:43722
Practice Address - Country:US
Practice Address - Phone:740-685-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.078363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2395322Medicaid