DR. NADEZDA A TRETYAKOVA (NPI# 1477832590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477832590 |
| Entity Type | Individual |
| Full Name | DR. NADEZDA A TRETYAKOVA |
| Credential | MD |
| Practice Address |
80 B Veterans Blvd I-40, Exit 102 Acoma NM 87034 |
| Mailing Address |
Po Box 130 San Fidel NM 87049-0130 |
| Practice Telephone | 5055525300 |
| Practice Fax Number | 5055525828 |
| Mailing Telephone | 5055525300 |
| Mailing Fax Number | 5055525828 |
| Enumeration Date | 2011-08-07 |
| Last Update Date | 2015-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | MD2013-0883 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | H3451 | 05 |
| Street Address |
80 B VETERANS BLVD I-40, EXIT 102 |
| City | ACOMA |
| State | NM |
| Zip Code | 87034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619970779 | James H Urbina | Internal Medicine | 80 B Veterans Blvd, I-40, Exit 102, Acoma, NM 87034 | 2005-05-23 |
| 1528604303 | Lisa Spero | Nurse Practitioner | 80 B Veterans Blvd, Acoma, NM 87034 | 2019-11-27 |
| 1689029860 | Muna S Sheikh | Internal Medicine | 80 B Veterans Blvd, Acoma, NM 87034 | 2016-04-26 |
| 1639523855 | Roberto Carlos Montes | Psychologist | 80 B Veterans Blvd, Acoma, NM 87034 | 2016-04-14 |
| 1972961068 | Aline Bayard | Nurse Practitioner | 80 B Veterans Blvd, Acoma, NM 87034 | 2016-02-03 |
| 1093188724 | Janet E Dominguez | Nurse Practitioner | 80 B Veterans Blvd, Acoma, NM 87034 | 2015-11-03 |
| 1124491949 | Patricia A Monroe | Nurse Practitioner | 80 B Veterans Blvd, Acoma, NM 87034 | 2015-11-02 |
| 1033594122 | Hlengiwe Lindani Sibanda | Nurse Practitioner | 80 B Veterans Blvd, Acoma, NM 87034-0536 | 2015-07-30 |
| 1851774392 | Caleb Vanderveen | Family Medicine | 80 B Veterans Blvd, Acoma, NM 87034 | 2015-07-01 |
| 1669721122 | Shawn P Giorgianni | Emergency Medical Technician, Paramedic | 80 B Veterans Blvd, Acl-ihs, Acoma, NM 87034 | 2012-08-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114535192 | Troy Stephen Weeldreyer | Social Worker | 45 Pinsbaari Dr, Acoma, NM 87034 | 2020-07-16 |
| 1306486857 | Mallery Chino | Case Manager/Care Coordinator | 47 Pinsbarri Drive, Acoma, NM 87034 | 2020-01-13 |
| 1700340841 | Thomas Simon Vallo | Case Manager/Care Coordinator | 45 Pinbaari Drive, Acoma, NM 87034 | 2019-01-23 |
| 1649777053 | Amanda Jean Garcia | Counselor | 99b Sunrise Rd, Pueblo of Acoma, NM 87034 | 2018-04-11 |
| 1356850754 | Korey B Still | Dentist | 80 B Veterans Blvd., Acoma, NM 87034 | 2017-09-28 |
| 1508395278 | Shelby Bobelu | Social Worker | 45 Pinsbarri Dr., Acoma, NM 87034 | 2017-06-07 |
| 1558817270 | Amanda Lucario | Technician, Other | 1253 Haaku Road, Acoma, NM 87034 | 2016-09-01 |
| 1073961355 | Rhayna Dannielle Walizer | Social Worker | 45 Pinsbarri Dr, Acoma, NM 87034 | 2016-05-27 |
| 1417305715 | Everett Chavez | Counselor | 45 Pinsbaari, Acoma, NM 87034 | 2016-05-26 |
| 1952758047 | Lonnie Lewis | Counselor | 33 Pinsbaari Drive, Acoma, NM 87034 | 2016-05-18 |
| Find all providers in zip 87034 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
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| 1710596036 | Provider Cares Network LLC | General Practice | 10401 Montgomery Pkwy Ne Ste 1a, Albuquerque, NM 87111-3876 | 2020-07-23 |
| 1154948081 | Designed Health Options, LLC | General Practice | 5065 Corrales Rd., Corrales, NM 87048 | 2020-06-26 |
| 1538714381 | Uyama A Fernandez | General Practice | 400 Gold Ave Sw Ste 220, Albuquerque, NM 87102-3278 | 2019-08-08 |
| 1386180909 | Lisselle Marie Villarrubia Ocasio | General Practice | Msc10 6000 1 University of New Mexico, Albuquerque, NM 87131-5505 | 2017-01-07 |
| 1225586969 | Joan Goldsworthy | General Practice | Unm School of Medicine Msc09 5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2016-09-12 |
| 1033568902 | Karen Griest | General Practice | 68 Pinon Trl, Cedar Crest, NM 87008-9444 | 2016-06-10 |
| 1447610886 | Sean T Mcgee | General Practice | Univeristy of New Mexico, Albuquerque, NM 87131-0001 | 2016-02-27 |
| 1275901266 | Lynn Schrader Sweeney | General Practice | 701 Kerney Dr, Farmington, NM 87401-3660 | 2015-09-08 |
| 1942608708 | Marathon Health, Inc. | General Practice | 2208 W Main St, C/o Concho Employee Health Center, Artesia, NM 88210-3720 | 2014-12-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.