MEDICARE: MS. DANIJO KATHLEEN CRANE 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	163WC1500X	Community Health Registered Nurse	RN9454821	FL

General Provider Information

NPI Number	:	1972067122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIJO KATHLEEN CRANE RN

Provider Business Mailing Address
First Line	:	504 DATE ST
Second Line	:
City	:	CLEWISTON
State	:	FL
Zip	:	33440-3138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 S MAIN ST
Second Line	:
City	:	LABELLE
State	:	FL
Zip	:	33935-4629
Country	:	US
Telephone Number	:	863-302-6054
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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