Healthcare Provider Details

I. General information

NPI: 1699615260
Provider Name (Legal Business Name): MEREDITH GENTRY
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: MEREDITH MORTON

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LAKES DR
NORTHFIELD IL
60093-2734
US

IV. Provider business mailing address

3 LAKES DR
NORTHFIELD IL
60093-2734
US

V. Phone/Fax

Practice location:
  • Phone: 847-732-8570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041482026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: