Provider Demographics
NPI:1578835385
Name:KANE, TERRA LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LEIGH
Last Name:KANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9498
Mailing Address - Country:US
Mailing Address - Phone:608-444-0875
Mailing Address - Fax:
Practice Address - Street 1:6115 SOUTH CT
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9498
Practice Address - Country:US
Practice Address - Phone:608-444-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167075-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice