Provider Demographics
NPI:1851564793
Name:TATE, DEEANN MARIE
Entity Type:Individual
Prefix:
First Name:DEEANN
Middle Name:MARIE
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:RR 1 BOX 47A
Mailing Address - Street 2:
Mailing Address - City:DALLAS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62330-9611
Mailing Address - Country:US
Mailing Address - Phone:309-337-4629
Mailing Address - Fax:217-852-9919
Practice Address - Street 1:RR 1 BOX 47A
Practice Address - Street 2:
Practice Address - City:DALLAS CITY
Practice Address - State:IL
Practice Address - Zip Code:62330-9611
Practice Address - Country:US
Practice Address - Phone:309-337-4629
Practice Address - Fax:217-852-9919
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT30017377621347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle