Healthcare Provider Details

I. General information

NPI: 1508836685
Provider Name (Legal Business Name): TRISHA ELLEN KILIANY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA KILIANY ROSS CRNA

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

IV. Provider business mailing address

4810 POINT FOSDICK DR NW BOX #224
GIG HARBOR WA
98335-1711
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5081
  • Fax:
Mailing address:
  • Phone: 360-402-5767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA#AP30006474
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA243002
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00119304
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: