Provider Demographics
NPI:1871578609
Name:MILEHAM, TERRI LEE (CFNP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LEE
Last Name:MILEHAM
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LEE
Other - Last Name:ARNOLD-MILEHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:9050 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3023
Mailing Address - Country:US
Mailing Address - Phone:623-255-8648
Mailing Address - Fax:
Practice Address - Street 1:9050 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-255-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ390OtherLICENSE
AZ1174514756OtherGROUP NPI
AZZ125676Medicare PIN
AZ60788Medicare ID - Type Unspecified
AZ390OtherLICENSE
AZZ22506Medicare PIN