Individual
MRS. DEBRA DENISE TETRAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3124 WIESE WAY, SACRAMENTO, CA 95833
(916) 922-8023
Mailing address
8340 CEREUS CT, ANTELOPE, CA 95843
(916) 723-2797
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN114498
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012840
EPS
CA
01
—
5927935
PIN
CA
Enumeration date
05/07/2007
Last updated
07/08/2007
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