Healthcare Provider Details

I. General information

NPI: 1609969856
Provider Name (Legal Business Name): MAUREEN KING KILBY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PERRY POINT VA
PERRY POINT MD
21902
US

IV. Provider business mailing address

PO BOX 544
RISING SUN MD
21911-0544
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-658-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR118114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: