Provider Demographics
NPI:1235479569
Name:KINCAID, CANSAS LORRAINE (RN)
Entity type:Individual
Prefix:
First Name:CANSAS
Middle Name:LORRAINE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E 337TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2934
Mailing Address - Country:US
Mailing Address - Phone:440-339-8887
Mailing Address - Fax:
Practice Address - Street 1:1208 E 337TH ST
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2934
Practice Address - Country:US
Practice Address - Phone:440-339-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN355602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse