Individual
LISA MARIE P GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3998 RED LION ROAD, PHILADELPHIA, PA 19114
(215) 807-8000
(215) 807-8235
Mailing address
1075 VALLEY RD, WARMINSTER, PA 18974-1846
(267) 249-8838
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
VP006632B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030744
HIGHMARK BLUE SHIELD
PA
01
—
500014598
RAILROAD MEDICARE
PA
Enumeration date
07/24/2006
Last updated
04/09/2018
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