Mary Nichole Tate

NPI #1467000414 in Humboldt, Tennessee

Provider Information

NPI Number: 1467000414
Entity Type: Individual
Name: Mary Nichole Tate
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Sep 3, 2019
Last Updated: Sep 3, 2019

Practice Location

Address: 4505 E MAIN ST
City: Humboldt
State: Tennessee
ZIP Code: 38343-6410
Phone: (731) 420-6443

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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