Doctor Name: | SUNJA TATE |
NPI Number: | 1124411004 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | R878941 |
Business Practice Address: | 300 Rawls Drive Suite 100 Mccomb, MS - 396492877 |
Business Phone Number: | 6016847623 |
Business Fax Number: | 8777959891 |
Mailing Address: | 300 Rawls Dr, Suite 100 MCCOMB |
State: | MS |
Postal Code: | 396482877 |
Phone Number: | 6016847623 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2015 |
NPI Last Update Date: | 08/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R878941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |