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NPI Code Detail

MEDICARE: RYLEE PETERSEN

MEDICARE: RYLEE PETERSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator14201933-3503UT

General Provider Information

NPI Number : 1508709460
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYLEE PETERSEN
Provider Business Mailing Address
First Line : 2946 W 3450 N
Second Line :
City : FARR WEST
State : UT
Zip : 84404-8616
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12760 S PARK AVE UNIT 520
Second Line :
City : RIVERTON
State : UT
Zip : 84065-3422
Country : US
Telephone Number : 801-407-0047
Fax Number : 888-400-9232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ RYLEE PETERSEN ” Practice Location

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