Provider Demographics
NPI:1508836685
Name:KILIANY, TRISHA ELLEN (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:ELLEN
Last Name:KILIANY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:TRISHA
Other - Middle Name:KILIANY
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4810 POINT FOSDICK DR NW
Mailing Address - Street 2:BOX #224
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1711
Mailing Address - Country:US
Mailing Address - Phone:360-402-5767
Mailing Address - Fax:
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00119304163W00000X
171000000X
WACRNA#AP30006474367500000X
MERNA243002367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA367500000XMedicaid
WAG8898257OtherMDCR PTAN (K)
MERNA243002OtherMAINE BOARD OF NURSING
WAG8912171OtherMDCR PTAN (P)