Provider Demographics
NPI:1609132588
Name:KILLIAN, EILEEN W (RN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:W
Last Name:KILLIAN
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 1:535 BRIAR PL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2666
Mailing Address - Country:US
Mailing Address - Phone:718-337-2473
Mailing Address - Fax:
Practice Address - Street 1:535 BRIAR PL
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2666
Practice Address - Country:US
Practice Address - Phone:718-337-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494789163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool