Provider Demographics
NPI:1720432396
Name:BRILEY, GLENDA EFETI
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:EFETI
Last Name:BRILEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10178 VOYAGER CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2240
Mailing Address - Country:US
Mailing Address - Phone:907-201-0403
Mailing Address - Fax:
Practice Address - Street 1:10178 VOYAGER CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2240
Practice Address - Country:US
Practice Address - Phone:907-201-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMEDICAIDMedicaid
AKMEDICARE PINMedicare PIN