Individual
MRS. MARTHA MARIE GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 W 95TH ST STE LL5, OAK LAWN, IL 60453-2575
(708) 891-1651
Mailing address
790 CAMPBELL AVE, CALUMET CITY, IL 60409-4306
(708) 891-1651
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
IL
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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