Provider Demographics
NPI:1154865392
Name:MIDDLETON, HEATHER (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 STATION ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-8830
Mailing Address - Country:US
Mailing Address - Phone:567-674-7544
Mailing Address - Fax:
Practice Address - Street 1:13575 STATION ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-8830
Practice Address - Country:US
Practice Address - Phone:567-674-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159010164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse