Provider Demographics
NPI:1750979969
Name:MIDDLETON, CHRYSTE LASHON (RN, CCM)
Entity type:Individual
Prefix:
First Name:CHRYSTE
Middle Name:LASHON
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GLEN ARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8881
Mailing Address - Country:US
Mailing Address - Phone:770-856-1780
Mailing Address - Fax:855-222-0084
Practice Address - Street 1:312 GLEN ARBOR LOOP
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8881
Practice Address - Country:US
Practice Address - Phone:770-856-1780
Practice Address - Fax:855-222-0084
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC223162163WG0000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty