Healthcare Provider Details

I. General information

NPI: 1952309676
Provider Name (Legal Business Name): PEGGY K WERTH MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22021 ECORSE RD
TAYLOR MI
48180-1847
US

IV. Provider business mailing address

14680 PARK ST
LIVONIA MI
48154-5155
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-4444
  • Fax: 313-291-7540
Mailing address:
  • Phone: 734-462-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704114570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: