Provider Demographics
NPI:1255666269
Name:KILLEAN, JUDI-ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:JUDI-ANN
Middle Name:
Last Name:KILLEAN
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 1:19 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2909
Mailing Address - Country:US
Mailing Address - Phone:631-874-6207
Mailing Address - Fax:
Practice Address - Street 1:19 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2909
Practice Address - Country:US
Practice Address - Phone:631-874-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse