Healthcare Provider Details

I. General information

NPI: 1134569965
Provider Name (Legal Business Name): KATHRYN KANE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 PARK AVE SUITE B
WORCESTER MA
01603-2537
US

IV. Provider business mailing address

548 PARK AVE SUITE B
WORCESTER MA
01603-2537
US

V. Phone/Fax

Practice location:
  • Phone: 774-272-2274
  • Fax:
Mailing address:
  • Phone: 774-272-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2279547
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: