Provider Demographics
NPI:1790083103
Name:KANE, NICOLE CAROLE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CAROLE
Last Name:KANE
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-8300
Mailing Address - Fax:207-564-8466
Practice Address - Street 1:897 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1029
Practice Address - Country:US
Practice Address - Phone:207-564-8300
Practice Address - Fax:207-564-8466
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily