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NPI Code Detail

MEDICARE: PEGGY K WERTH MSN, FNP

MEDICARE:   PEGGY K WERTH  MSN, FNP
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
1363LF0000XFamily Nurse Practitioner4704114570MI

General Provider Information

NPI Number : 1952309676
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY K WERTH MSN, FNP
Provider Business Mailing Address
First Line : 14680 PARK ST
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5155
Country : US
Telephone Number : 734-462-4835
Fax Number :
Provider Business Practice Location Address
First Line : 22021 ECORSE RD
Second Line :
City : TAYLOR
State : MI
Zip : 48180-1847
Country : US
Telephone Number : 313-291-4444
Fax Number : 313-291-7540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 03/07/2023

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