Provider Demographics
NPI:1609996099
Name:GILLARD, ALISA ANN (CST,CFA)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ANN
Last Name:GILLARD
Suffix:
Gender:F
Credentials:CST,CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8345
Mailing Address - Country:US
Mailing Address - Phone:337-583-7038
Mailing Address - Fax:337-558-6392
Practice Address - Street 1:1785 WALKER RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-8345
Practice Address - Country:US
Practice Address - Phone:337-583-7038
Practice Address - Fax:337-558-6392
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF01173246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist