Provider Demographics
NPI:1144711227
Name:GALLANT, AMY LYNNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:GALLANT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2752
Mailing Address - Country:US
Mailing Address - Phone:508-212-9796
Mailing Address - Fax:
Practice Address - Street 1:283 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:508-212-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232739163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty