Provider Demographics
NPI:1063823250
Name:GENTRY, CHRISTINE M (BS, RN, CWHE, CCP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GENTRY
Suffix:
Gender:F
Credentials:BS, RN, CWHE, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2170
Mailing Address - Country:US
Mailing Address - Phone:860-235-0525
Mailing Address - Fax:
Practice Address - Street 1:12 SWAN LN
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2170
Practice Address - Country:US
Practice Address - Phone:860-235-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN45326163W00000X
CT084627163W00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163W00000XNursing Service ProvidersRegistered Nurse