Provider Demographics
NPI:1164769949
Name:MIDDLEBROOKS, AMY SUE (RN, BC, CCM)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:RN, BC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 PARK MILL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7032
Mailing Address - Country:US
Mailing Address - Phone:614-745-7129
Mailing Address - Fax:614-559-9771
Practice Address - Street 1:6720 PARK MILL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7032
Practice Address - Country:US
Practice Address - Phone:614-745-7129
Practice Address - Fax:614-559-9771
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN - 266658163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00060949OtherCCM
OHRN-266658OtherRN