Healthcare Provider Details

I. General information

NPI: 1023236486
Provider Name (Legal Business Name): LYNETTE H GILLARD GSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 READ BLVD
NEW ORLEANS LA
70127-2226
US

IV. Provider business mailing address

7260 READ BLVD
NEW ORLEANS LA
70127-2226
US

V. Phone/Fax

Practice location:
  • Phone: 504-220-9131
  • Fax: 832-446-6792
Mailing address:
  • Phone: 504-220-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7710
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number7710
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: