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General NPI Number Information
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NPI Number | 1932871258
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Entity Type | Individual
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Provider Name | ALYSSAH GENTRY FNP
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 326 NICHOLS RD
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City | FITCHBURG
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State | MA
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Zip | 01420-1914
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Country | US
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Telephone | 978-878-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 927 PLEASANT ST APT 1
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City | WORCESTER
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State | MA
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Zip | 01602-1909
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Country | US
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Telephone | 774-402-4774
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2310990
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License Number State | MA
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