Provider Demographics
NPI:1215329727
Name:KANE, JEROME S (RN)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:S
Last Name:KANE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:S
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:915 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-652-4100
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022538163WE0003X, 163WG0600X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0600XNursing Service ProvidersRegistered NurseGerontology