Provider Demographics
NPI:1548341704
Name:GALLANT, DONNA L (CPED, BOCO, CMF)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:GALLANT
Suffix:
Gender:F
Credentials:CPED, BOCO, CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769
Mailing Address - Country:US
Mailing Address - Phone:207-762-3808
Mailing Address - Fax:207-762-3809
Practice Address - Street 1:40 NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2269
Practice Address - Country:US
Practice Address - Phone:207-762-3808
Practice Address - Fax:207-762-3809
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist