MEDICARE: MRS. MINITA KING MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861634156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINITA KING MILLER

Provider Business Mailing Address
First Line	:	1821 WOODDALE CT
Second Line	:	STE 210
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1535
Country	:	US
Telephone Number	:	225-803-6531
Fax Number	:	225-356-4156

Provider Business Practice Location Address
First Line	:	1821 WOODDALE CT
Second Line	:	STE 210
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1535
Country	:	US
Telephone Number	:	225-803-6531
Fax Number	:	225-356-4156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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