Provider Demographics
NPI:1205882115
Name:PATE, PHYLLIS ANN (RN, C)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANN
Last Name:PATE
Suffix:
Gender:F
Credentials:RN, C
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:ANN
Other - Last Name:NESTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, C
Mailing Address - Street 1:200 MERCY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7303
Mailing Address - Country:US
Mailing Address - Phone:563-582-0145
Mailing Address - Fax:563-582-0722
Practice Address - Street 1:200 MERCY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7303
Practice Address - Country:US
Practice Address - Phone:563-582-0145
Practice Address - Fax:563-582-0722
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA039289163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health