1376566588 NPI number — MRS. JANET MARY TATE RNFA

Table of content: MRS. JANET MARY TATE RNFA (NPI 1376566588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376566588 NPI number — MRS. JANET MARY TATE RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
JANET
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEIGNAN
Provider Other First Name:
JANET
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN RNFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376566588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9901 E FLOWER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-354-3051
Provider Business Mailing Address Fax Number:
480-354-4083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 N 36TH ST
Provider Second Line Business Practice Location Address:
STE #200
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-330-3850
Provider Business Practice Location Address Fax Number:
480-396-6939
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN136992 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)