Provider Demographics
NPI:1376634766
Name:KANE, NANCY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KANE-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5100
Mailing Address - Fax:515-643-5150
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 3262
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-643-5100
Practice Address - Fax:515-643-5150
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26800207RE0101X
IAMD-26800207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265173Medicaid
IA48973OtherWELLMARK
IAD80155Medicare UPIN
IAI6443Medicare ID - Type Unspecified