MEDICARE: KISHA NICOLA MCCAIN C.R.N.A.

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	367500000X	Certified Registered Nurse Anesthetist	522397	NY

General Provider Information

NPI Number	:	1376520122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA NICOLA MCCAIN C.R.N.A.

Provider Business Mailing Address
First Line	:	128 E 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3702
Country	:	US
Telephone Number	:	347-546-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3702
Country	:	US
Telephone Number	:	718-245-4408
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/10/2018

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