Provider Demographics
NPI:1245418078
Name:BATES, JOHANNE SYLVIE (GNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNE
Middle Name:SYLVIE
Last Name:BATES
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:MS
Other - First Name:JOHANNE
Other - Middle Name:SYLVIE
Other - Last Name:LETENDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1528112363L00000X
CO130307363LG0600X
MNR152811-2363LG0600X
MNCNP 3244363LG0600X
MN3244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500007312Medicare PIN