Provider Demographics
NPI:1902451461
Name:GINYARD, TRETISIOUS MONIQUE
Entity type:Individual
Prefix:
First Name:TRETISIOUS
Middle Name:MONIQUE
Last Name:GINYARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 FORT DAVIS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1042
Mailing Address - Country:US
Mailing Address - Phone:202-352-0638
Mailing Address - Fax:202-581-4654
Practice Address - Street 1:1675 FORT DAVIS ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1042
Practice Address - Country:US
Practice Address - Phone:202-352-0638
Practice Address - Fax:202-581-4654
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide