Provider Demographics
NPI:1760164479
Name:SIAS, JONTERRA
Entity Type:Individual
Prefix:
First Name:JONTERRA
Middle Name:
Last Name:SIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIONNE IMPERIO
Other - Middle Name:TRANSPORTATION
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:206 VAN BUREN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-5532
Mailing Address - Country:US
Mailing Address - Phone:337-296-4249
Mailing Address - Fax:
Practice Address - Street 1:206 VAN BUREN DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-5532
Practice Address - Country:US
Practice Address - Phone:337-296-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)