Healthcare Provider Details

I. General information

NPI: 1699768341
Provider Name (Legal Business Name): LISA M. KANE M.S.N, R.N., C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BONNIBEE CT
RALEIGH NC
27612-3468
US

IV. Provider business mailing address

1801 BONNIBEE CT
RALEIGH NC
27612-3468
US

V. Phone/Fax

Practice location:
  • Phone: 919-602-1087
  • Fax: 919-847-0780
Mailing address:
  • Phone: 919-602-1087
  • Fax: 919-847-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number063909
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: