Provider Demographics
NPI:1699768341
Name:KANE, LISA M (MSN, RN, CS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:KANE
Suffix:
Gender:F
Credentials:MSN, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BONNIBEE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3468
Mailing Address - Country:US
Mailing Address - Phone:919-602-1087
Mailing Address - Fax:919-847-0780
Practice Address - Street 1:1801 BONNIBEE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3468
Practice Address - Country:US
Practice Address - Phone:919-602-1087
Practice Address - Fax:919-847-0780
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063909163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2598154Medicare PIN