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General NPI Number Information
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NPI Number | 1104153006
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Entity Type | Individual
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Provider Name | CHRISSIE MIDDLETON
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Gender | Female
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 4109 E NORTH ST STE 300C
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City | GREENVILLE
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State | SC
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Zip | 29615-6227
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Country | US
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Telephone | 864-409-7041
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Fax | 864-428-1286
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Provider Business Mailing Address
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Address Line | PO BOX 287
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City | GREENVILLE
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State | SC
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Zip | 29602-0287
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Country | US
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Telephone | 864-729-8330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3964
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3964
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License Number State | SC
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