Provider Demographics
NPI:1134901622
Name:BATE, VICTORINE EGBE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VICTORINE
Middle Name:EGBE
Last Name:BATE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5848
Mailing Address - Country:US
Mailing Address - Phone:647-457-2494
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932-2000
Practice Address - Country:US
Practice Address - Phone:509-317-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026528363LF0000X
WAAP61519181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily