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NPI Code Detail

MEDICARE: MARY MIDDLETON R.N.

MEDICARE: MARY MIDDLETON R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse615196CA

General Provider Information

NPI Number : 1619015344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MIDDLETON R.N.
Provider Business Mailing Address
First Line : 12608 SHADY CREEK DR
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-9312
Country : US
Telephone Number : 530-265-9057
Fax Number :
Provider Business Practice Location Address
First Line : 24077 STATE HIGHWAY 49
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-8519
Country : US
Telephone Number : 530-265-9057
Fax Number : 530-292-3803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 07/08/2007

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