Provider Demographics
NPI:1730729518
Name:MILES, MARLEASTE DENISE
Entity type:Individual
Prefix:
First Name:MARLEASTE
Middle Name:DENISE
Last Name:MILES
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 1:317 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71073-2917
Mailing Address - Country:US
Mailing Address - Phone:318-707-3791
Mailing Address - Fax:
Practice Address - Street 1:317 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2917
Practice Address - Country:US
Practice Address - Phone:318-707-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator