Provider Demographics
NPI:1700825502
Name:PATE, MARY ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:PATE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:1504 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3475
Practice Address - Fax:251-434-3837
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-067016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05420342Medicaid
AL51532878OtherBLUE CROSS
S47747Medicare UPIN
AL00038894Medicare ID - Type UnspecifiedRAILROAD PGBA