Individual
DR. NADEZDA A TRETYAKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
80 B VETERANS BLVD, I-40, EXIT 102, ACOMA, NM 87034
(505) 552-5300
(505) 552-5828
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5300
(505) 552-5828
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD2013-0883
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
Enumeration date
08/07/2011
Last updated
07/09/2015
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