Provider Demographics
NPI:1962169755
Name:VILAYVANH, BRIAN B (RN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:VILAYVANH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 BLAIR RD STE 100
Mailing Address - Street 2:PMB 134494
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-506-8442
Mailing Address - Fax:214-303-9608
Practice Address - Street 1:5473 BLAIR RD STE 100
Practice Address - Street 2:PMB 134494
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-506-8442
Practice Address - Fax:214-303-9608
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731237146L00000X
390200000X
TX927885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program