Healthcare Provider Details

I. General information

NPI: 1134901622
Provider Name (Legal Business Name): VICTORINE EGBE BATE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 01/23/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN STREET
GRANGER WA
98932-2000
US

IV. Provider business mailing address

626 HAMMOND DR
MANSFIELD TX
76063-5848
US

V. Phone/Fax

Practice location:
  • Phone: 509-317-2182
  • Fax:
Mailing address:
  • Phone: 647-457-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026528
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61519181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: