Individual
JENNA LEIGH TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
60599
MN
208000000X
Pediatrics Physician
R9745
IA
Other
Enumeration date
06/01/2013
Last updated
06/28/2016
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