Provider Demographics
NPI:1780269670
Name:TATE, SHONIECE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SHONIECE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6084 APPLE TREE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0305
Mailing Address - Country:US
Mailing Address - Phone:901-207-4804
Mailing Address - Fax:901-255-0758
Practice Address - Street 1:6084 APPLE TREE DR STE 10
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0305
Practice Address - Country:US
Practice Address - Phone:901-207-4804
Practice Address - Fax:901-255-0758
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1773888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse