Provider Demographics
NPI:1588487375
Name:PETRUNIC, SCOTT
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:PETRUNIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 E 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-4314
Mailing Address - Country:US
Mailing Address - Phone:907-317-0478
Mailing Address - Fax:
Practice Address - Street 1:4600 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4314
Practice Address - Country:US
Practice Address - Phone:907-346-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician