Individual
AMANDA L GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
100 ALFRED LOOP, APT 201, CHESAPEAKE, VA 23320-3059
(979) 256-9452
Mailing address
2489 FM 2187 RD, SEALY, TX 77474-8438
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/30/2006
Last updated
01/07/2009
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