Provider Demographics
NPI:1851724710
Name:KANE, GILLIAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13915 DRURY RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9311
Mailing Address - Country:US
Mailing Address - Phone:740-358-8224
Mailing Address - Fax:
Practice Address - Street 1:13915 DRURY RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9311
Practice Address - Country:US
Practice Address - Phone:740-358-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.153578-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse