Provider Demographics
NPI:1427073188
Name:MIDDLETON, DEBRA L (FNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:STEWART-BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 ROBERTS AVE NE
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-7101
Mailing Address - Country:US
Mailing Address - Phone:701-797-2221
Mailing Address - Fax:701-797-2457
Practice Address - Street 1:1200 ROBERTS AVE NE
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-7101
Practice Address - Country:US
Practice Address - Phone:701-797-2221
Practice Address - Fax:701-797-2457
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23285363LF0000X
MNR175779-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19536Medicaid
MN856400000Medicaid
MN856400000Medicaid
MN856400000Medicaid
S09197Medicare UPIN
ND19536Medicaid
MB0174540OtherDEA