Provider Demographics
NPI:1598538985
Name:MIDDLETON, BRUCE PATRICK (BSN)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PATRICK
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026
Mailing Address - Country:US
Mailing Address - Phone:616-410-0472
Mailing Address - Fax:
Practice Address - Street 1:1413 CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026
Practice Address - Country:US
Practice Address - Phone:616-410-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704361672364SP2800X
KY1181877364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative