Provider Demographics
NPI:1891028643
Name:PETERSON, TONI LISA (RN)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:LISA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:LISA
Other - Last Name:MCCALEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 GABRIEL AVE APT 301
Mailing Address - Street 2:APT 301
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2165
Mailing Address - Country:US
Mailing Address - Phone:620-423-9148
Mailing Address - Fax:
Practice Address - Street 1:1527 MADISON ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1751
Practice Address - Country:US
Practice Address - Phone:620-378-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-91254-041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse