Provider Demographics
NPI:1376851394
Name:KANE, CISSE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CISSE
Middle Name:
Last Name:KANE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 THOMPSON HEIGHTS AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1649
Mailing Address - Country:US
Mailing Address - Phone:513-541-5005
Mailing Address - Fax:
Practice Address - Street 1:1600 THOMPSON HEIGHTS AVE APT 412
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1649
Practice Address - Country:US
Practice Address - Phone:513-541-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH355585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse