Maryellen Tetreault

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN2309070 Issued in MA

Practice address

288 Lyman St
Westborough, MA 01581-2664

Phone

(508) 475-2696

NPI assigned

Oct 30, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1609410927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463 HOLLIS ST",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017028647",
            "telephone_number": "774-276-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 LYMAN ST",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015812664",
            "telephone_number": "508-475-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETREAULT",
        "first_name": "MARYELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2309070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah A Szala Cicchetti, OTR/L
• Brad Parker Taylor, PHD
• Jennifer Dawn Teicher, M.S, CGC
• Eriola Terova, M.D
• Sotiraq Terova, M.D.
• The Commonwealth of Massachusetts
• The Dental Place
• Thomas Fordham Brewer, M.D., P.C.
• Laure Thomas, LMHC
• Thrive Collective Metrowest

• Pediatric Nurse Practitioner in Westborough, MA
• Providers in Westborough, MA by specialty
• Pediatric Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.