Provider Demographics
NPI:1780686519
Name:GAITOR, VONDA LYNETTE (NP)
Entity Type:Individual
Prefix:DR
First Name:VONDA
Middle Name:LYNETTE
Last Name:GAITOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1625 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4308
Practice Address - Country:US
Practice Address - Phone:504-309-5015
Practice Address - Fax:504-309-5012
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA599991-1097363L00000X
LAAP01097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1537853Medicaid
LAQ42189Medicare UPIN
LA4H438F669Medicare PIN
LA4H438Medicare PIN
LA1537853Medicaid