Provider Demographics
NPI:1497457279
Name:KANE, CASEY C (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:C
Last Name:KANE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 NAYMUT ST
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3423
Mailing Address - Country:US
Mailing Address - Phone:920-858-3112
Mailing Address - Fax:
Practice Address - Street 1:378 NAYMUT ST
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3423
Practice Address - Country:US
Practice Address - Phone:920-858-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13719-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily