Provider Demographics
NPI:1275699290
Name:KILLEEN, MAUREEN R (CNS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:R
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2135
Mailing Address - Country:US
Mailing Address - Phone:706-549-7763
Mailing Address - Fax:706-549-0428
Practice Address - Street 1:1435 OGLETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2135
Practice Address - Country:US
Practice Address - Phone:706-549-7763
Practice Address - Fax:706-549-0428
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036683163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health