Provider Demographics
NPI:1205379880
Name:PATE, JESSICA (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 IDLEWILD AVE
Mailing Address - Street 2:STE 3-4
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3834
Mailing Address - Country:US
Mailing Address - Phone:410-820-4888
Mailing Address - Fax:
Practice Address - Street 1:508 IDLEWILD AVE
Practice Address - Street 2:STE 3-4
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3834
Practice Address - Country:US
Practice Address - Phone:410-820-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226409367A00000X
FL9166812367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife