MEDICARE: CHRISTINE GENTRY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200990	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118383	OTHER	NC	RN
2	200990	OTHER	NC	FAMILY NP

General Provider Information

NPI Number	:	1962459248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GENTRY NP

Provider Business Mailing Address
First Line	:	10 SUNNYBROOK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-4049
Country	:	US
Telephone Number	:	919-250-3925
Fax Number	:	919-212-0475

Provider Business Practice Location Address
First Line	:	10 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1808
Country	:	US
Telephone Number	:	910-250-3925
Fax Number	:	919-212-0475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/24/2008

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