Healthcare Provider Details

I. General information

NPI: 1801163332
Provider Name (Legal Business Name): MICHELLE DWAN PELTON C.N.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 207
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4745 OGLETOWN STANTON RD SUITE 207
NEWARK DE
19713-2067
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-9000
  • Fax: 302-368-9004
Mailing address:
  • Phone: 302-368-9000
  • Fax: 302-368-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0031912
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0000162
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: