Provider Demographics
NPI:1407226665
Name:MIDDLETON, LAUREN BROWN (CERTHAIRLOSS SPECIAL)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROWN
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CERTHAIRLOSS SPECIAL
Other - Prefix:
Other - First Name:HAIR
Other - Middle Name:MAJESTY
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15614 NORMANS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7126
Mailing Address - Country:US
Mailing Address - Phone:803-325-4276
Mailing Address - Fax:
Practice Address - Street 1:14136 RIVERGATE PKWY STE 118
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8889
Practice Address - Country:US
Practice Address - Phone:803-325-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLH 62241744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management