Provider Demographics
NPI:1902098932
Name:BRILL, DONNA LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
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 1:38 COUNTY ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:BOMBAY
Mailing Address - State:NY
Mailing Address - Zip Code:12914
Mailing Address - Country:US
Mailing Address - Phone:518-358-2978
Mailing Address - Fax:
Practice Address - Street 1:2383 STATE ROUTE 95
Practice Address - Street 2:
Practice Address - City:BOMBAY
Practice Address - State:NY
Practice Address - Zip Code:12914
Practice Address - Country:US
Practice Address - Phone:518-358-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0770101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01439629Medicaid