Provider Demographics
NPI:1396517959
Name:KANE, SAMANTHA (RD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROGER WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4741
Mailing Address - Country:US
Mailing Address - Phone:847-975-6214
Mailing Address - Fax:
Practice Address - Street 1:20 ROGER WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4741
Practice Address - Country:US
Practice Address - Phone:847-975-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered