Provider Demographics
NPI:1699032235
Name:KANE, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COUNTY HOUSE RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-6178
Mailing Address - Country:US
Mailing Address - Phone:845-677-4060
Mailing Address - Fax:845-677-4076
Practice Address - Street 1:131 COUNTY HOUSE RD
Practice Address - Street 2:SUITE 217
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-6178
Practice Address - Country:US
Practice Address - Phone:845-677-4060
Practice Address - Fax:845-677-4076
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse