Healthcare Provider Details

I. General information

NPI: 1154258150
Provider Name (Legal Business Name): CAITLYN GENTNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47145 JEFFERSON AVE
CHESTERFIELD MI
48047-5137
US

IV. Provider business mailing address

47145 JEFFERSON AVE
CHESTERFIELD MI
48047-5137
US

V. Phone/Fax

Practice location:
  • Phone: 810-705-0303
  • Fax:
Mailing address:
  • Phone: 810-705-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number90719
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704373670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: