Healthcare Provider Details

I. General information

NPI: 1831661255
Provider Name (Legal Business Name): MICHELE BEAUCHAMP ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 BAY ROAD
DOVER DE
19901
US

IV. Provider business mailing address

665 SOUTH BAY RD UNIT B
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-608-5306
  • Fax:
Mailing address:
  • Phone: 302-608-5306
  • Fax: 302-336-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0011010
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: