Provider Demographics
NPI:1871335794
Name:KIENE, ELIZABETH MARIE (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:KIENE
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 1:6710 MCRAE HWY
Mailing Address - Street 2:
Mailing Address - City:MC RAE HELENA
Mailing Address - State:GA
Mailing Address - Zip Code:31037-2505
Mailing Address - Country:US
Mailing Address - Phone:478-595-9757
Mailing Address - Fax:
Practice Address - Street 1:6710 MCRAE HWY
Practice Address - Street 2:
Practice Address - City:MC RAE HELENA
Practice Address - State:GA
Practice Address - Zip Code:31037-2505
Practice Address - Country:US
Practice Address - Phone:478-595-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247531163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health