Provider Demographics
NPI:1225261316
Name:GARGOTTO, LINDSAY ANN (PRACTICUM STUDENT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANN
Last Name:GARGOTTO
Suffix:
Gender:F
Credentials:PRACTICUM STUDENT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:WORKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADIOLOGICAL TECH
Mailing Address - Street 1:2805 WAREHAM RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-2445
Mailing Address - Country:US
Mailing Address - Phone:502-489-0956
Mailing Address - Fax:
Practice Address - Street 1:2805 WAREHAM RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-4024
Practice Address - Country:US
Practice Address - Phone:502-489-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY603390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program