Provider Demographics
NPI:1487031357
Name:PETERS, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:PETERS
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 1:14313 NE 20TH AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1487
Mailing Address - Country:US
Mailing Address - Phone:360-719-2951
Mailing Address - Fax:
Practice Address - Street 1:14313 NE 20TH AVE
Practice Address - Street 2:SUITE A105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1487
Practice Address - Country:US
Practice Address - Phone:360-719-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator