Individual
MARISA VELLA GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
7033 SAINT ANDREWS RD STE 305, COLUMBIA, SC 29212-1181
(803) 936-7480
(803) 936-7481
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
18959
SC
363LP2300X
Primary Care Nurse Practitioner
Primary
18959
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4359
—
SC
Enumeration date
07/22/2014
Last updated
10/27/2020
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