Provider Demographics
NPI:1801163332
Name:PELTON, MICHELLE DWAN (CNM)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DWAN
Last Name:PELTON
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-9000
Mailing Address - Fax:302-368-9004
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-9000
Practice Address - Fax:302-368-9004
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEL1-0031912163W00000X
DELK-0000162367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse