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NPI Code Detail

MEDICARE: BLONDENA UNLIA MILEY FNP

MEDICARE: BLONDENA UNLIA MILEY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner258518AZ
2363LP2300XPrimary Care Nurse Practitioner258518AZ

General Provider Information

NPI Number : 1013580687
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLONDENA UNLIA MILEY FNP
Provider Business Mailing Address
First Line : 309 LAKE HAVASU AVE S
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-9309
Country : US
Telephone Number : 928-453-1970
Fax Number : 855-538-3082
Provider Business Practice Location Address
First Line : 309 LAKE HAVASU AVE S
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-9309
Country : US
Telephone Number : 928-453-1970
Fax Number : 855-538-3082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2021
Last Update Date : 10/23/2025

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Directions to “ BLONDENA UNLIA MILEY FNP” Practice Location

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