Mary Louise Tate, AGNP-C

Individual provider Active NPI Gerontology Nurse Practitioner · Montross, VA

NPI 1750147435 · NPPES record last updated Feb 21, 2024

Key facts

NPI
1750147435
Entity type
Individual (NPI type 1)
Primary specialty
Gerontology Nurse Practitioner 363LG0600X
License
0024189538 (VA)
Practice address
434 Pierce LN
Montross, VA 22520-2252
Phone
(804) 366-0913
NPI assigned
Feb 21, 2024
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No

National Provider Directory

Medicare enrollment (NPD)
Yes

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 0024189538 VA Yes

Addresses

Primary practice location

434 Pierce LN
Montross, VA 22520-2252

Mailing address

434 Pierce LN
Montross, VA 22520-3121
Phone (804) 366-0913

Other providers in Montross, VA

All providers in Montross, VA · Gerontology Nurse Practitioner in Virginia

Sources for this page

Verify at the official NPI Registry.