MEDICARE: ELIZABETH MARIE KILTY R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	201505411RN	OR

General Provider Information

NPI Number	:	1467822668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE KILTY R.N.

Provider Business Mailing Address
First Line	:	52195 E TERRA FERN DR
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-7402
Country	:	US
Telephone Number	:	971-322-9507
Fax Number	:

Provider Business Practice Location Address
First Line	:	52195 E TERRA FERN DR
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-7402
Country	:	US
Telephone Number	:	971-322-9507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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