Provider Demographics
NPI:1114106556
Name:GRIFFIN, KILEY ANN (RN)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:ANN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LEVERETT AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1277
Mailing Address - Country:US
Mailing Address - Phone:617-569-2523
Mailing Address - Fax:
Practice Address - Street 1:20 LEVERETT AVE
Practice Address - Street 2:APT 5B
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1277
Practice Address - Country:US
Practice Address - Phone:617-569-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse