Healthcare Provider Details

I. General information

NPI: 1376254383
Provider Name (Legal Business Name): AMBER MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9059 W LAKE PLEASANT PKWY STE E540
PEORIA AZ
85382-8396
US

IV. Provider business mailing address

9059 W LAKE PLEASANT PKWY STE E540
PEORIA AZ
85382-8396
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-3380
  • Fax:
Mailing address:
  • Phone: 623-322-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: