Active NPI
Deborah R Tetreault, WHNP
- Women's Health Nurse Practitioner
- Portland, ME
National Provider Identifier
1700972445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- R023566
- Practice address
- 272 Congress St.
Portland, ME 04101 - Phone
- (207) 874-2466
- Fax
- (207) 774-4625
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | R023566 | ME | Primary |
Addresses
Primary practice location
272 Congress St.
Portland, ME 04101
Mailing address
39 Wallace Ave
So. Portland, ME 04106
Phone (207) 761-0650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1700972445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 WALLACE AVE",
"city": "SO. PORTLAND",
"state": "ME",
"postal_code": "04106",
"telephone_number": "207-761-0650",
"fax_number": "207-761-8198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 CONGRESS ST.",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04101",
"telephone_number": "207-874-2466",
"fax_number": "207-774-4625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETREAULT",
"first_name": "DEBORAH",
"middle_name": "R",
"credential": "WHNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "ME",
"license": "R023566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.