Provider Demographics
NPI:1366762981
Name:MIDDLETON, CHARISSE
Entity type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
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 1:1022 SANDFIDDLER DR
Mailing Address - Street 2:APT. 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8638
Mailing Address - Country:US
Mailing Address - Phone:919-217-3541
Mailing Address - Fax:
Practice Address - Street 1:1022 SANDFIDDLER DR
Practice Address - Street 2:APT. 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8638
Practice Address - Country:US
Practice Address - Phone:919-217-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1038543747P1801X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker