Provider Demographics
NPI:1134301229
Name:KANE, MARY K (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:KANE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4109
Mailing Address - Country:US
Mailing Address - Phone:410-430-9050
Mailing Address - Fax:410-548-3313
Practice Address - Street 1:1101 LAKE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3143
Practice Address - Country:US
Practice Address - Phone:410-749-6776
Practice Address - Fax:410-742-1126
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR047549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily