Provider Demographics
NPI:1477109197
Name:BETCH, PEGGY A (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:A
Last Name:BETCH
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26080 SHULTS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:MD
Mailing Address - Zip Code:21640-1517
Mailing Address - Country:US
Mailing Address - Phone:410-924-4549
Mailing Address - Fax:
Practice Address - Street 1:100 PATRIOTS WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5800
Practice Address - Country:US
Practice Address - Phone:302-856-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily