Healthcare Provider Details

I. General information

NPI: 1720127210
Provider Name (Legal Business Name): CHELIE M MIDDLETON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3674
US

IV. Provider business mailing address

9774 OLIVE ST
BLOOMINGTON CA
92316-2021
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-8455
  • Fax: 562-949-4807
Mailing address:
  • Phone: 626-780-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: