Provider Demographics
NPI:1679162283
Name:KILEY, MARY J (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:KILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1981 ARBOR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9528
Mailing Address - Country:US
Mailing Address - Phone:734-915-7258
Mailing Address - Fax:517-266-1530
Practice Address - Street 1:100 POWELL DR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8644
Practice Address - Country:US
Practice Address - Phone:517-266-1481
Practice Address - Fax:517-266-1530
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704154875163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health