Provider Demographics
NPI:1457358871
Name:TATE, MARY DALE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DALE
Last Name:TATE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7666
Mailing Address - Country:US
Mailing Address - Phone:718-599-2403
Mailing Address - Fax:
Practice Address - Street 1:70 ROSS ST
Practice Address - Street 2:5H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7666
Practice Address - Country:US
Practice Address - Phone:718-599-2403
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222832-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse