Provider Demographics
NPI:1184127169
Name:TENNEFOSS, DEMETRIA F (NP)
Entity type:Individual
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First Name:DEMETRIA
Middle Name:F
Last Name:TENNEFOSS
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1459
Mailing Address - Fax:360-729-3066
Practice Address - Street 1:123 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2313
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-248-3644
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2020-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR2017076T8RN163W00000X
OR201803923NP-PP363L00000X
WAAP61074664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty