Provider Demographics
NPI:1992787881
Name:KANE, PATRICIA A (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KANE-MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 S HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8352
Practice Address - Country:US
Practice Address - Phone:269-278-1145
Practice Address - Fax:269-273-9611
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704081213363LF0000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992787881Medicaid
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MI110G510580OtherBCBS GROUP-INTERNAL MEDICINE
MI3172180 10Medicaid
MIMI1609032Medicare PIN
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MI238506Medicare Oscar/Certification
MI110G510580OtherBCBS GROUP-INTERNAL MEDICINE
MI238511Medicare Oscar/Certification