Basic Information
| Provider Information | |||||||||
| NPI: | 1215983556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 655 | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497070655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893564049 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11745 US HIGHWAY 23 S | ||||||||
| Address2: | |||||||||
| City: | OSSINEKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497669582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894712156 | ||||||||
| FaxNumber: | 9893583741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AK143485 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4295157 | 05 | MI | MEDICAID | 4295166 | 05 | MI | MEDICAID | 0F06016 | 01 | MI | MEDICARE BILL PAY TO | OTHER | 4295148 | 05 | MI | MEDICAID | 4883874 | 05 | MI | MEDICAID |