Provider Demographics
NPI:1750635058
Name:KANE, CAROLE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
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 1:5520 BUGSY SIEGAL CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-2400
Mailing Address - Country:US
Mailing Address - Phone:702-889-0445
Mailing Address - Fax:
Practice Address - Street 1:5520 BUGSY SIEGAL CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2400
Practice Address - Country:US
Practice Address - Phone:702-889-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64815251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health