Healthcare Provider Details

I. General information

NPI: 1114106556
Provider Name (Legal Business Name): KILEY ANN GRIFFIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LEVERETT AVE APT 5B
EAST BOSTON MA
02128-1277
US

IV. Provider business mailing address

20 LEVERETT AVE APT 5B
EAST BOSTON MA
02128-1277
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-2523
  • Fax:
Mailing address:
  • Phone: 617-569-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number268230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: