Individual
SHANTALE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1018 HARDING ST, LAFAYETTE, LA 70503-2400
(337) 262-8326
Mailing address
122 MADI CIR # 122, LAFAYETTE, LA 70506-9350
(337) 303-6466
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456789
—
LA
Enumeration date
11/07/2022
Last updated
11/07/2022
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