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Individual
DEMETRIA F TENNEFOSS
Active
Individual
DEMETRIA F TENNEFOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2017076T8RN
OR
363L00000X
Nurse Practitioner
201803923NP-PP
OR
363L00000X
Nurse Practitioner
Primary
AP61074664
WA
Other
Enumeration date
03/15/2018
Last updated
08/10/2020
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