Provider Demographics
NPI:1457782575
Name:MILEM, BRIANNA NICOLE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:MILEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 S 72ND EAST AVE APT C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-6757
Mailing Address - Country:US
Mailing Address - Phone:602-653-6883
Mailing Address - Fax:
Practice Address - Street 1:4989 S 72ND EAST AVE
Practice Address - Street 2:APT C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-6757
Practice Address - Country:US
Practice Address - Phone:602-653-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical