Basic Information
| Provider Information | |||||||||
| NPI: | 1053477000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRILLER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREY | ||||||||
| OtherFirstName: | NANCY | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 990 SYLVAN WAY | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983102851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604793657 | ||||||||
| FaxNumber: | 3603737616 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 SYLVAN WAY | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983102851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604793657 | ||||||||
| FaxNumber: | 3603737616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00031412 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 192575000 | 01 | WA | OWCP | OTHER | 911577098-07 | 01 | WA | KITSAP PHYSICIANS SERVICE | OTHER | 1086818 | 05 | WA | MEDICAID | 911577098 | 01 | WA | PREMERA BLUE CROSS | OTHER | 911577098 | 01 | WA | UNIFORM MEDICAL PLAN | OTHER | GR6798 | 01 | WA | REGENCE | OTHER | 013194010 | 01 | WA | GROUP HEALTH COOPERATIVE | OTHER | 050028290 | 01 | WA | RAILROAD MEDICARE | OTHER | 37566 | 01 | WA | LABOR AND INDUSTRIES | OTHER |