Provider Demographics
NPI:1417070855
Name:KILLILEA, KATHLEEN NELLIGAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:NELLIGAN
Last Name:KILLILEA
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 1:1 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1716
Mailing Address - Country:US
Mailing Address - Phone:508-533-4664
Mailing Address - Fax:
Practice Address - Street 1:1 RICHARD RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1716
Practice Address - Country:US
Practice Address - Phone:508-533-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705462Medicaid