Healthcare Provider Details

I. General information

NPI: 1225124381
Provider Name (Legal Business Name): MARCENE ELLYN KANE CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP MESCALERO INDIAN HOSPITAL
MESCALERO NM
88340
US

IV. Provider business mailing address

PO BOX 810
MESCALERO NM
88340-0810
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-4441
  • Fax:
Mailing address:
  • Phone: 505-464-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YC3301X
TaxonomyHospital Based Coding Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: