Provider Demographics
NPI:1356811517
Name:BRILL, HAILEE (RD, LD)
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:BRILL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9492 CANTATA CREST CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3203
Mailing Address - Country:US
Mailing Address - Phone:920-946-8106
Mailing Address - Fax:
Practice Address - Street 1:9492 CANTATA CREST CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-3203
Practice Address - Country:US
Practice Address - Phone:920-946-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86066267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered