Provider Demographics
NPI:1790116168
Name:MIDDLETON, KARREN LAVONNE (RN)
Entity Type:Individual
Prefix:
First Name:KARREN
Middle Name:LAVONNE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KARREN
Other - Middle Name:LAVONNE
Other - Last Name:GEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1919 GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1619
Mailing Address - Country:US
Mailing Address - Phone:541-980-8375
Mailing Address - Fax:
Practice Address - Street 1:1919 GARRISON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1619
Practice Address - Country:US
Practice Address - Phone:541-980-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142223RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse