Provider Demographics
NPI:1821287343
Name:BRILLIANT, MARY VIRGINIA (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA
Last Name:BRILLIANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN
Mailing Address - Street 2:STE. 205
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1922
Mailing Address - Country:US
Mailing Address - Phone:502-375-3242
Mailing Address - Fax:502-375-4331
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:502-375-3242
Practice Address - Fax:502-375-4331
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily