MEDICARE: KATHRYN FORREST TATE CNM
Medicare Provider Information
Scope of Practice
The following information about the specialty of the provider is available:
| # |
Taxonomy Code |
Taxonomy |
License Number |
License Number State |
| 1 | 367A00000X | Advanced Practice Midwife | ARNP 1957052 | FL |
| NPI Number |
: |
1629060447 |
| Entity Type Code |
: |
Individual |
| Provider Name (Legal Business Name) |
: |
KATHRYN FORREST TATE CNM
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| Provider Business Mailing Address |
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| First Line |
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UNIT 3865
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Second Line
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City
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APO
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State
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AE
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Zip
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:
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09126
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Country
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DE
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Telephone Number
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4-965-6169
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Fax Number
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3168
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Provider Business Practice Location Address
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First Line
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UNIT 3865
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Second Line
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City
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APO
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State
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AE
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Zip
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09126
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Country
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DE
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Telephone Number
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4-965-6169
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Fax Number
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3168
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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 Number
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Provider Enumeration Date
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:
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08/18/2005
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Last Update Date
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:
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07/08/2007
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