Provider Demographics
NPI:1558793513
Name:GALLANT, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GALLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:15107 SUTTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4049
Mailing Address - Country:US
Mailing Address - Phone:818-465-3119
Mailing Address - Fax:818-465-3121
Practice Address - Street 1:15107 SUTTON ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4049
Practice Address - Country:US
Practice Address - Phone:818-465-3119
Practice Address - Fax:818-465-3121
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700269163W00000X
CA11145086163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse