Healthcare Provider Details

I. General information

NPI: 1679162283
Provider Name (Legal Business Name): MARY J KILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR
DUNDEE MI
48131-8644
US

IV. Provider business mailing address

1981 ARBOR CREEK DR
MONROE MI
48162-9528
US

V. Phone/Fax

Practice location:
  • Phone: 517-266-1481
  • Fax: 517-266-1530
Mailing address:
  • Phone: 734-915-7258
  • Fax: 517-266-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704154875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: