Provider Demographics
NPI:1124611868
Name:KANE, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 8351
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-8351
Mailing Address - Country:US
Mailing Address - Phone:970-925-8184
Mailing Address - Fax:
Practice Address - Street 1:109 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2174
Practice Address - Country:US
Practice Address - Phone:970-925-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0089432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse