Provider Demographics
NPI:1922865633
Name:MIDDLETON, CASEY LYNN
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:56 WRIGHT AVE # 843A
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-5009
Mailing Address - Country:US
Mailing Address - Phone:619-977-9068
Mailing Address - Fax:
Practice Address - Street 1:56 WRIGHT AVE # 843A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-5009
Practice Address - Country:US
Practice Address - Phone:619-977-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program