Provider Demographics
NPI:1144805995
Name:KILLEEN PENA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KILLEEN PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 N LAURELGLEN BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-8810
Mailing Address - Country:US
Mailing Address - Phone:206-321-0894
Mailing Address - Fax:
Practice Address - Street 1:7812 N LAURELGLEN BLVD APT D
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-8810
Practice Address - Country:US
Practice Address - Phone:206-321-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula