Provider Demographics
NPI:1568737328
Name:GAILLARD, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:GAILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 HOLTON HILL
Mailing Address - Street 2:PO BOX 473
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0473
Mailing Address - Country:US
Mailing Address - Phone:802-498-8881
Mailing Address - Fax:
Practice Address - Street 1:324 SOUTH BAYLEY-HAZEN RD
Practice Address - Street 2:
Practice Address - City:RYEGATE
Practice Address - State:VT
Practice Address - Zip Code:05042
Practice Address - Country:US
Practice Address - Phone:802-584-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0078863164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse