Individual
TANYA THERIAULT
Active
Individual
TANYA THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
98997
CT
363LF0000X
Family Nurse Practitioner
Primary
005103
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
07/27/2012
Last updated
10/22/2012
Update your record
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