Provider Demographics
NPI:1174243505
Name:SHURINE PATE, PLLC
Entity type:Organization
Organization Name:SHURINE PATE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHURINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AGNP, AGPCNP-BC
Authorized Official - Phone:928-277-4622
Mailing Address - Street 1:3101 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7180
Mailing Address - Country:US
Mailing Address - Phone:928-277-4622
Mailing Address - Fax:928-515-1219
Practice Address - Street 1:3101 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7180
Practice Address - Country:US
Practice Address - Phone:928-277-4622
Practice Address - Fax:928-515-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care