Provider Demographics
NPI:1538740410
Name:MIDDLETON, EMILY RAYNA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RAYNA
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6022
Mailing Address - Country:US
Mailing Address - Phone:803-351-0020
Mailing Address - Fax:
Practice Address - Street 1:1408 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6022
Practice Address - Country:US
Practice Address - Phone:803-351-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84934163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant