Provider Demographics
NPI:1285694059
Name:MIDDLETON, EILEEN M (PA)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3549 SOUTHERN HILLS DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4736
Mailing Address - Country:US
Mailing Address - Phone:712-274-6729
Mailing Address - Fax:712-274-6744
Practice Address - Street 1:600 4TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1750
Practice Address - Country:US
Practice Address - Phone:712-234-0220
Practice Address - Fax:712-234-0225
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA001320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37256OtherWELLMARK
IA37256OtherWELLMARK
IAI13105Medicare PIN