Provider Demographics
NPI:1912776527
Name:CRILLY, KIMBERLY (RN, CDCES)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CRILLY
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17424 MONITOR DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2246
Mailing Address - Country:US
Mailing Address - Phone:301-312-0817
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD STE 410
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3863
Practice Address - Country:US
Practice Address - Phone:571-999-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114588163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse