Healthcare Provider Details

I. General information

NPI: 1841054574
Provider Name (Legal Business Name): VICTORIA GENTRY RN, CMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 119TH ST STE B
OKLAHOMA CITY OK
73170-2625
US

IV. Provider business mailing address

2601 SW 119TH ST STE B
OKLAHOMA CITY OK
73170-2625
US

V. Phone/Fax

Practice location:
  • Phone: 405-295-5525
  • Fax:
Mailing address:
  • Phone: 405-295-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: