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NPI Code Detail

MEDICARE: CAROL JEAN PETERS

MEDICARE: CAROL JEAN PETERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care AttendantNV

General Provider Information

NPI Number : 1477496628
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL JEAN PETERS
Provider Business Mailing Address
First Line : 4245 S GRAND CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-7161
Country : US
Telephone Number : 702-751-0356
Fax Number :
Provider Business Practice Location Address
First Line : 4245 S GRAND CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-7161
Country : US
Telephone Number : 702-751-0356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ CAROL JEAN PETERS ” Practice Location

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