Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 258518 | AZ |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 258518 | AZ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 258518 | AZ |
NPI | 1013580687 |
---|---|
Provider Name | Blondena Unlia Miley |
First Address | Lake Havasu City, AZ 86405-3539 |
Second Address | Lake Havasu City, AZ 86403-5689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2021 |
Last Update Date | 05/11/2021 |