Individual
ELIZABETH DIANA GENTRY - BREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Mailing address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
060857
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1955710
—
LA
Enumeration date
01/23/2007
Last updated
12/23/2014
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