Provider Demographics
NPI:1124482997
Name:BATE, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:BATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WHITE BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1625
Mailing Address - Country:US
Mailing Address - Phone:202-704-3640
Mailing Address - Fax:
Practice Address - Street 1:110 WHITE BIRCH CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1625
Practice Address - Country:US
Practice Address - Phone:202-704-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1004839164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse