Individual
MS. GANIELLE MARVA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ASSISTED LIVING ADMN
Contact information
Practice address
2773 SE CLARETON TER, PORT ST LUCIE, FL 34952-6621
(954) 657-1812
Mailing address
2773 SE CLARETON TER, PORT ST LUCIE, FL 34952-6621
(954) 657-1812
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
FL
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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