Provider Demographics
NPI:1013580687
Name:MILEY, BLONDENA UNLIA (FNP)
Entity Type:Individual
Prefix:
First Name:BLONDENA
Middle Name:UNLIA
Last Name:MILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3539
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3539
Mailing Address - Country:US
Mailing Address - Phone:928-855-4224
Mailing Address - Fax:928-855-5114
Practice Address - Street 1:1741 MESQUITE AVE STE 200A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5689
Practice Address - Country:US
Practice Address - Phone:928-453-0890
Practice Address - Fax:501-781-3982
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258518163WG0000X, 363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care