Healthcare Provider Details

I. General information

NPI: 1407200603
Provider Name (Legal Business Name): AMBERLY GENTRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 RING RD SUITE B
HARRISON OH
45030-2764
US

IV. Provider business mailing address

620 RING RD
HARRISON OH
45030-2764
US

V. Phone/Fax

Practice location:
  • Phone: 513-845-4558
  • Fax: 513-845-4568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.19000-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: