Provider Demographics
NPI:1962895284
Name:ERUIMY-KILEY, MARIE JUDITH LUCIE (CPM,LM)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JUDITH LUCIE
Last Name:ERUIMY-KILEY
Suffix:
Gender:F
Credentials:CPM,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-0088
Mailing Address - Country:US
Mailing Address - Phone:802-999-3586
Mailing Address - Fax:
Practice Address - Street 1:1511 PRINDLE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445
Practice Address - Country:US
Practice Address - Phone:802-999-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0109596176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife