Provider Demographics
NPI:1689831042
Name:BRILEY, ALICE MARIE (RN MA CNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:MARIE
Last Name:BRILEY
Suffix:
Gender:F
Credentials:RN MA CNP
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:MARIE
Other - Last Name:BRILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MA CNP
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:VIRGINIA PIPER CANCER INSTITUTE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-5364
Mailing Address - Fax:
Practice Address - Street 1:2260 135TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3978
Practice Address - Country:US
Practice Address - Phone:763-862-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2008004346363LA2200X
MNR-164198-9163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology