Provider Demographics
NPI:1770927220
Name:MIDDLETON, MARQUENTTA A
Entity type:Individual
Prefix:MRS
First Name:MARQUENTTA
Middle Name:A
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PEAK VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1390
Mailing Address - Country:US
Mailing Address - Phone:702-420-1317
Mailing Address - Fax:
Practice Address - Street 1:41 PEAK VILLA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1390
Practice Address - Country:US
Practice Address - Phone:702-420-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst