Provider Demographics
NPI:1194303552
Name:MIDDLETON, ALICIA (CNA)
Entity type:Individual
Prefix:
First Name:ALICIA
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 1:12 RIVERWATCH LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-1560
Mailing Address - Country:US
Mailing Address - Phone:540-556-3693
Mailing Address - Fax:
Practice Address - Street 1:12 RIVERWATCH LN
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-1560
Practice Address - Country:US
Practice Address - Phone:540-556-3693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00129004376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00129004OtherMD BOARD OF NURSING