Healthcare Provider Details

I. General information

NPI: 1376257329
Provider Name (Legal Business Name): ANNE M KANE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3482 BROADWAY ST
BOULDER CO
80304-1824
US

IV. Provider business mailing address

1290 NORWOOD AVE
BOULDER CO
80304-1208
US

V. Phone/Fax

Practice location:
  • Phone: 303-413-7500
  • Fax:
Mailing address:
  • Phone: 303-748-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0068570
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: