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General NPI Number Information
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NPI Number | 1326131889
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Entity Type | Individual
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Provider Name | MARIAN K TATE ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 137 KANSAS STREET
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City | WALSH
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State | CO
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Zip | 81090-0608
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Country | US
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Telephone | 719-324-5253
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Fax | 719-324-5621
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Provider Business Mailing Address
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Address Line | 137 KANSAS ST PO BOX 608
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City | WALSH
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State | CO
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Zip | 81090-0608
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Country | US
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Telephone | 719-324-5253
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Fax | 719-324-5621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 44312
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 54031
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License Number State | CO
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