Provider Demographics
NPI:1356681522
Name:PENA, KILSY ISABEL (RN)
Entity Type:Individual
Prefix:
First Name:KILSY
Middle Name:ISABEL
Last Name:PENA
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 1:256 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4050
Mailing Address - Country:US
Mailing Address - Phone:504-496-2470
Mailing Address - Fax:
Practice Address - Street 1:3616 S I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1874
Practice Address - Country:US
Practice Address - Phone:504-838-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA128928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse