Provider Demographics
NPI:1962635417
Name:PATE, TONY L (RN)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:L
Last Name:PATE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AVON PKWY
Mailing Address - Street 2:APT 5
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4023
Mailing Address - Country:US
Mailing Address - Phone:315-558-1696
Mailing Address - Fax:
Practice Address - Street 1:3 AVON PKWY
Practice Address - Street 2:APT 5
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-4023
Practice Address - Country:US
Practice Address - Phone:315-558-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse