Individual
MARY NICHOLE TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4505 E MAIN ST, HUMBOLDT, TN 38343-6410
(731) 420-6443
Mailing address
4505 E MAIN ST, HUMBOLDT, TN 38343-6410
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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