Provider Demographics
NPI:1912939380
Name:MILLER, MARGARET LYNN (RN,RD,CDE)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN,RD,CDE
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:LYNN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6117
Mailing Address - Fax:985-230-6653
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6117
Practice Address - Fax:985-230-6653
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA965133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD5141OtherRR MEDICARE NUMBER
4C691Medicare ID - Type Unspecified