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General NPI Number Information
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NPI Number | 1346903051
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Entity Type | Individual
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Provider Name | MARIE S TATE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 617 W PATRICK ST STE 223
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City | FREDERICK
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State | MD
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Zip | 21701-4027
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Country | US
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Telephone | 240-405-8084
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E PATRICK ST UNIT 241
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City | FREDERICK
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State | MD
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Zip | 21705-7511
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Country | US
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Telephone | 240-319-9404
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R179162
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License Number State | MD
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