Provider Demographics
NPI:1295009140
Name:GILLETTE, FALLON LYNNE
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:LYNNE
Last Name:GILLETTE
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 1:710 SW RAILROAD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-4961
Mailing Address - Country:US
Mailing Address - Phone:985-542-2223
Mailing Address - Fax:985-542-2206
Practice Address - Street 1:710 SW RAILROAD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4961
Practice Address - Country:US
Practice Address - Phone:985-542-2223
Practice Address - Fax:985-542-2206
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator