Provider Demographics
NPI:1639453467
Name:MIDDLETON, VALERIE RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:RENEE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8186 LARK BROWN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6433
Mailing Address - Country:US
Mailing Address - Phone:410-730-3399
Mailing Address - Fax:
Practice Address - Street 1:8186 LARK BROWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6433
Practice Address - Country:US
Practice Address - Phone:410-730-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD898LMedicare PIN