Provider Demographics
NPI:1326131889
Name:TATE, MARIAN K (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:K
Last Name:TATE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:137 KANSAS ST
Mailing Address - Street 2:PO BOX 608
Mailing Address - City:WALSH
Mailing Address - State:CO
Mailing Address - Zip Code:81090-0608
Mailing Address - Country:US
Mailing Address - Phone:719-324-5253
Mailing Address - Fax:719-324-5621
Practice Address - Street 1:137 KANSAS STREET
Practice Address - Street 2:
Practice Address - City:WALSH
Practice Address - State:CO
Practice Address - Zip Code:81090-0608
Practice Address - Country:US
Practice Address - Phone:719-324-5253
Practice Address - Fax:719-324-5621
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44312363LF0000X
CO54031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100282330AMedicaid
CO72000856Medicaid
KS100282330AMedicaid
COC338628Medicare ID - Type Unspecified
CO72000856Medicaid