Provider Demographics
NPI:1952359192
Name:KANE, PENNIE MARIE
Entity Type:Individual
Prefix:
First Name:PENNIE
Middle Name:MARIE
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNIE
Other - Middle Name:M
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:33 CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3955
Mailing Address - Country:US
Mailing Address - Phone:603-424-4438
Mailing Address - Fax:603-622-1132
Practice Address - Street 1:27 LOWELL ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1646
Practice Address - Country:US
Practice Address - Phone:603-622-2007
Practice Address - Fax:603-622-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0268512308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340998Medicaid
NH30340998Medicaid
NHKANP2841Medicare ID - Type Unspecified