Healthcare Provider Details

I. General information

NPI: 1538778709
Provider Name (Legal Business Name): TANISHA NICOLE KANE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 JENNIFER POND WAY
RICHMOND VA
23223-5852
US

IV. Provider business mailing address

5312 JENNIFER POND WAY
RICHMOND VA
23223-5852
US

V. Phone/Fax

Practice location:
  • Phone: 571-458-8061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001252946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: