Provider Demographics
NPI:1851741607
Name:SUH FOMINYAM, MILVIA NWUNFOR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MILVIA
Middle Name:NWUNFOR
Last Name:SUH FOMINYAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16778 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7433
Mailing Address - Country:US
Mailing Address - Phone:330-926-8215
Mailing Address - Fax:
Practice Address - Street 1:16778 W APACHE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7433
Practice Address - Country:US
Practice Address - Phone:330-926-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily