Individual provider · NPI-1
Ganielle Marva Peterson, Assisted Living Admn
Nursing Home Administrator · Port St Lucie, FL
NPI number1285241489
StatusActive
Last updated in NPPESSep 30, 2020
Details
- NPI
- 1285241489
- Entity type
- Individual (NPI-1)
- Name
- Ms. Ganielle Marva Peterson
- Credential
- Assisted Living Admn
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 30, 2020
- Certification date
- Sep 30, 2020
- Last updated
- Sep 30, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 376G00000X | Nursing Home Administrator | – | FL | Yes |
Practice location
2773 Se Clareton TerPort St Lucie, FL 34952-6621
Phone 954-657-1812
Mailing address
2773 Se Clareton TerPort St Lucie, FL 34952-6621
Phone 954-657-1812
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