Provider Demographics
NPI:1649928896
Name:TATES, AUNTASHAE NIZA
Entity type:Individual
Prefix:
First Name:AUNTASHAE
Middle Name:NIZA
Last Name:TATES
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 1:1752 CLEMMENS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2108
Mailing Address - Country:US
Mailing Address - Phone:330-918-0796
Mailing Address - Fax:
Practice Address - Street 1:1752 CLEMMENS AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2108
Practice Address - Country:US
Practice Address - Phone:330-918-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402088060718376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide