Individual
MRS. CARLA J GENTRY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8181 CORNERSTONE DR, HAYDEN, ID 83835
(208) 772-0785
(208) 762-2704
Mailing address
8181 CORNERSTONE DR, HAYDEN, ID 83835
(208) 772-0785
(208) 762-2704
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP566A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1344192
MEDICARE
ID
Enumeration date
11/22/2005
Last updated
07/08/2007
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