Healthcare Provider Details

I. General information

NPI: 1720537541
Provider Name (Legal Business Name): SUZETTE KANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BOISE AVE
LOVELAND CO
80538-5006
US

IV. Provider business mailing address

4470 S. LEMAY AVE APT 515
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-820-4640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0102834
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: