Provider Demographics
NPI:1790313849
Name:TETREAULT, CYNTHIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELIZABETH
Last Name:TETREAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30209 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4249
Mailing Address - Country:US
Mailing Address - Phone:206-445-8785
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DRIVE, SUITE 2120
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program