Provider Demographics
NPI:1952309676
Name:WERTH, PEGGY K (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:K
Last Name:WERTH
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14680 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5155
Mailing Address - Country:US
Mailing Address - Phone:734-462-4835
Mailing Address - Fax:
Practice Address - Street 1:22021 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1847
Practice Address - Country:US
Practice Address - Phone:313-291-4444
Practice Address - Fax:313-291-7540
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MW0805905OtherDEA NUMBER
MIW46926Medicare UPIN