MEDICARE: MS. DONNA LEAH KANE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	426908-1	NY
2	163WS0200X	School Registered Nurse	426908-1	NY

General Provider Information

NPI Number	:	1114265105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA LEAH KANE RN

Provider Business Mailing Address
First Line	:	15870 COUNTY ROUTE 5
Second Line	:
City	:	CLAYTON
State	:	NY
Zip	:	13624-3116
Country	:	US
Telephone Number	:	315-686-2539
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 ESSELSTYNE ST
Second Line	:
City	:	CAPE VINCENT
State	:	NY
Zip	:	13618
Country	:	US
Telephone Number	:	315-654-2142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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