Provider Demographics
NPI:1407733264
Name:MILLER, MAIA G
Entity type:Individual
Prefix:
First Name:MAIA
Middle Name:G
Last Name:MILLER
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 1:306 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5141
Mailing Address - Country:US
Mailing Address - Phone:985-224-9376
Mailing Address - Fax:
Practice Address - Street 1:306 E 24TH ST
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5141
Practice Address - Country:US
Practice Address - Phone:985-224-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals