MEDICARE: MELISSA GENTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	378643511299	OH

General Provider Information

NPI Number	:	1699176016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GENTRY

Provider Business Mailing Address
First Line	:	1610 S GETTYSBURG AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-4107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 S GETTYSBURG AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-4107
Country	:	US
Telephone Number	:	937-397-0969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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Directions to “ MELISSA GENTRY ” Practice Location

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