Healthcare Provider Details

I. General information

NPI: 1598203531
Provider Name (Legal Business Name): MARY KILIANSKI CNM, WHNP-BV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JANSSON

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-1000
  • Fax: 937-399-7355
Mailing address:
  • Phone: 937-523-1000
  • Fax: 937-399-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0034926
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: