Provider Demographics
NPI:1770528374
Name:BRILES, ANDREA (PA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:BRILES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1534
Mailing Address - Country:US
Mailing Address - Phone:618-327-8236
Mailing Address - Fax:
Practice Address - Street 1:705 SOUTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1534
Practice Address - Country:US
Practice Address - Phone:611-832-7823
Practice Address - Fax:618-327-2209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26935Medicare ID - Type Unspecified
S11083Medicare UPIN