Provider Demographics
NPI:1427184415
Name:TATE, HERLANIUS M
Entity Type:Individual
Prefix:MS
First Name:HERLANIUS
Middle Name:M
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 1:1114 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-7705
Mailing Address - Country:US
Mailing Address - Phone:504-945-0911
Mailing Address - Fax:504-945-1193
Practice Address - Street 1:1112 FRANKLIN AVE.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-7705
Practice Address - Country:US
Practice Address - Phone:504-945-0911
Practice Address - Fax:504-945-1193
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10626251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1466433Medicaid