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NPI Code Detail

MEDICARE: TROY PETERSEN

MEDICARE:   TROY  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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1760950364
Entity Type Code : Individual
Provider Name (Legal Business Name) : TROY PETERSEN
Provider Business Mailing Address
First Line : 2775 SILVERTON WAY
Second Line :
City : SPARKS
State : NV
Zip : 89436-7417
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3785 BAKER LN STE 201
Second Line :
City : RENO
State : NV
Zip : 89509-5454
Country : US
Telephone Number : 775-996-3890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2018
Last Update Date : 01/17/2023

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Directions to “ TROY PETERSEN ” Practice Location

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