Provider Demographics
NPI:1700157187
Name:PETERS, ELLAREE YVETTE
Entity Type:Individual
Prefix:MRS
First Name:ELLAREE
Middle Name:YVETTE
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 1:8 RUSTIC LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-7421
Mailing Address - Country:US
Mailing Address - Phone:912-508-4360
Mailing Address - Fax:912-349-1220
Practice Address - Street 1:8 RUSTIC LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-7421
Practice Address - Country:US
Practice Address - Phone:912-508-4360
Practice Address - Fax:912-349-1220
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator