Provider Demographics
NPI:1689090789
Name:KANE, SUSAN MEREDITH (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MEREDITH
Last Name:KANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BLUE RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6692
Mailing Address - Country:US
Mailing Address - Phone:919-786-5001
Mailing Address - Fax:919-786-5051
Practice Address - Street 1:2406 BLUE RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6692
Practice Address - Country:US
Practice Address - Phone:919-786-5001
Practice Address - Fax:919-786-5051
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006757363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics