Provider Demographics
NPI:1225785181
Name:TATE, MORGAN EARLISSA
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:EARLISSA
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UNIVERSITY DR SE APT 206
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-2070
Mailing Address - Country:US
Mailing Address - Phone:612-296-7975
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY DR SE APT 206
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-2070
Practice Address - Country:US
Practice Address - Phone:612-296-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator