Provider Demographics
NPI:1548213622
Name:CRANE, KATHLEEN M (CRNFA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CRANE
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N 1ST ST.
Mailing Address - Street 2:#280
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-345-6545
Mailing Address - Fax:208-345-1213
Practice Address - Street 1:333 N 1ST ST.
Practice Address - Street 2:#280
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-345-6545
Practice Address - Fax:208-345-1213
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-16173163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010027660OtherBLUE SHIELD
ID54338OtherBLUE CROSS