Provider Demographics
NPI:1396193272
Name:PETERSON, TONYA RENEE
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:RENEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:RENEE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26300 FORD RD # 418
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2854
Mailing Address - Country:US
Mailing Address - Phone:313-355-7640
Mailing Address - Fax:
Practice Address - Street 1:26300 FORD RD # 418
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2854
Practice Address - Country:US
Practice Address - Phone:313-355-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider