Provider Demographics
NPI:1891707246
Name:GAILLARD, SANDRY P (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRY
Middle Name:P
Last Name:GAILLARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SANDRY
Other - Middle Name:W
Other - Last Name:GAILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5698
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5272
Practice Address - Country:US
Practice Address - Phone:828-650-8167
Practice Address - Fax:828-687-0729
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138157367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050497Medicaid
NC2613527Medicare ID - Type Unspecified