Healthcare Provider Details

I. General information

NPI: 1376617167
Provider Name (Legal Business Name): MAUREEN KILRAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3059 GRAFTON RD
BRUNSWICK OH
44212
US

IV. Provider business mailing address

3059 GRAFTON RD
BRUNSWICK OH
44212-2307
US

V. Phone/Fax

Practice location:
  • Phone: 440-476-8428
  • Fax:
Mailing address:
  • Phone: 440-476-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.000720RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.000720RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: