Healthcare Provider Details

I. General information

NPI: 1699820126
Provider Name (Legal Business Name): VERA TATE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

219 REVERMEDE CT
NEWPORT NEWS VA
23602-8311
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 757-249-2345
  • Fax: 757-249-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number0001081955
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: