Individual
MRS. NICOLE MARIE GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2114 RIVERSIDE DR, SUITE 103, MOUNT VERNON, WA 98273-5453
(136) 848-1934
Mailing address
2114 RIVERSIDE DR, SUITE 103, MOUNT VERNON, WA 98273-5453
(136) 848-1934
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 00019293
WA
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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