Provider Demographics
NPI:1295456507
Name:MILLEWA, AMNA ABRAHAM
Entity type:Individual
Prefix:
First Name:AMNA
Middle Name:ABRAHAM
Last Name:MILLEWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMONA
Other - Middle Name:IBRAHIM
Other - Last Name:MILLEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 WESTRAC DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2338
Mailing Address - Country:US
Mailing Address - Phone:701-205-2390
Mailing Address - Fax:
Practice Address - Street 1:1202 WESTRAC DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2338
Practice Address - Country:US
Practice Address - Phone:701-205-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker