Provider Demographics
NPI:1629665641
Name:HAVILAND, KYLIE HOPE (RN)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:HOPE
Last Name:HAVILAND
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 1:48 PALOMA AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2488
Mailing Address - Country:US
Mailing Address - Phone:951-719-4047
Mailing Address - Fax:
Practice Address - Street 1:48 PALOMA AVE APT 11
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2488
Practice Address - Country:US
Practice Address - Phone:951-719-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95225216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse