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General NPI Number Information
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NPI Number | 1841672409
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Entity Type | Individual
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Provider Name | ELLEN RACHEL GENTRY CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 111 HILLDALE DR
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City | CHATTANOOGA
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State | TN
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Zip | 37411-1806
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Country | US
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Telephone | 423-802-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 111 HILLDALE DR
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City | CHATTANOOGA
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State | TN
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Zip | 37411-1806
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Country | US
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Telephone | 423-843-9252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN0000149664
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | GAA-CRNA000992
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 20658
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN0000149664
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 163WN0800X
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Taxonomy Name | Neuroscience Registered Nurse
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License Number | RN0000149664
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License Number State | TN
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