Provider Demographics
NPI:1346903051
Name:TATE, MARIE S (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:S
Last Name:TATE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E PATRICK ST UNIT 241
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-7511
Mailing Address - Country:US
Mailing Address - Phone:240-319-9404
Mailing Address - Fax:
Practice Address - Street 1:11670 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-3161
Practice Address - Country:US
Practice Address - Phone:404-058-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR179162363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health