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NPI Code Detail

MEDICARE: TONYA MARIE PETERSON

MEDICARE: TONYA MARIE PETERSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1700737590
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA MARIE PETERSON
Provider Business Mailing Address
First Line : 16941 EAGLE RIVER LOOP
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7824
Country : US
Telephone Number : 907-206-4421
Fax Number :
Provider Business Practice Location Address
First Line : 16941 EAGLE RIVER LOOP
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7824
Country : US
Telephone Number : 907-206-4421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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Directions to “ TONYA MARIE PETERSON ” Practice Location

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