Basic Information
| Provider Information | |||||||||
| NPI: | 1558381368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRILES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 COCHRANE CIR., ATTN: CREDENTIALS OFFICE | ||||||||
| Address2: | EVANS ARMY COMMUNITY HOSPITAL (EACH) USA MEDDAC | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | 5236 VALDEZ CIRCLE, BUILDING 5236 | ||||||||
| Address2: | US ARMY HEALTH CLINIC - DUGWAY PROVING GROUND | ||||||||
| City: | DUGWAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358312941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201540-3102 | UT | X | Nursing Service Providers | Registered Nurse | 163WX0106X | 201540-3102 | UT | X | Nursing Service Providers | Registered Nurse | Occupational Health | 364SC1501X | 201540-3102 | UT | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health |
No ID Information.