Tretyakova, Nadezda A

Tretyakova, Nadezda A is an individual health care provider with primary practice located at 80 B Veterans Blvd I-40, Exit 102, Acoma NM 87034. She recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as her primary health care specialty. Tretyakova, Nadezda A can be contacted via phone (505) 552-5300.

Contact Information

Primary practice address
80 B Veterans Blvd I-40, Exit 102 Acoma NM 87034
Phone: (505) 552-5300
Fax: (505) 552-5828
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X MD2013-0883 New Mexico

Profile Details

NPI number 1477832590
LBN Legal business name Tretyakova, Nadezda A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 7th, 2011
Last updated Jul 9th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477832590 NPPES
New Mexico MEDICAID H3451

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