Provider Demographics
NPI:1982601571
Name:KANE, NICOLE M (CNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:KANE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 W ALEXIS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1182
Mailing Address - Country:US
Mailing Address - Phone:419-474-9324
Mailing Address - Fax:885-287-0160
Practice Address - Street 1:4640 W ALEXIS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-1182
Practice Address - Country:US
Practice Address - Phone:419-474-9324
Practice Address - Fax:552-870-1608
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2412955Medicaid
OHKANP14903Medicare ID - Type Unspecified
OHQ07737Medicare UPIN