Provider Demographics
NPI:1720622137
Name:DENNIS, SIERRA V
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:V
Last Name:DENNIS
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 1:303 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2011
Mailing Address - Country:US
Mailing Address - Phone:985-446-2936
Mailing Address - Fax:985-446-2940
Practice Address - Street 1:303 HICKORY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2011
Practice Address - Country:US
Practice Address - Phone:985-446-2936
Practice Address - Fax:985-446-2940
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator