Provider Demographics
NPI:1669916201
Name:MIDDLETON, STELA (CNP)
Entity type:Individual
Prefix:
First Name:STELA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 JUAN TABO BLVD NE STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3979
Mailing Address - Country:US
Mailing Address - Phone:505-663-6242
Mailing Address - Fax:
Practice Address - Street 1:4001 JUAN TABO BLVD NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3979
Practice Address - Country:US
Practice Address - Phone:505-633-7898
Practice Address - Fax:505-355-1394
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM66287363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty