Provider Demographics
NPI:1639851785
Name:KANE, MARISA NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:NICOLE
Last Name:KANE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1405
Mailing Address - Country:US
Mailing Address - Phone:401-434-0022
Mailing Address - Fax:401-434-6111
Practice Address - Street 1:684 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1405
Practice Address - Country:US
Practice Address - Phone:401-434-0022
Practice Address - Fax:401-434-6111
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2355216363LF0000X
RIAPRN03739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily