Provider Demographics
NPI:1154914851
Name:MIDDLETON, BREJHAN (CNA)
Entity type:Individual
Prefix:
First Name:BREJHAN
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6349
Mailing Address - Country:US
Mailing Address - Phone:770-990-8266
Mailing Address - Fax:
Practice Address - Street 1:509 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6349
Practice Address - Country:US
Practice Address - Phone:770-990-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide