Provider Demographics
NPI:1225642564
Name:BURRAS, TONIA
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:BURRAS
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 1:232 JEFFER DR
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2190
Mailing Address - Country:US
Mailing Address - Phone:504-319-3784
Mailing Address - Fax:
Practice Address - Street 1:232 JEFFER DR
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-2190
Practice Address - Country:US
Practice Address - Phone:504-319-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
172A00000X
LA002780336172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver