Provider Demographics
NPI:1407502388
Name:GENTRY, TONI DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:DENISE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FIELD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6896
Mailing Address - Country:US
Mailing Address - Phone:336-414-0173
Mailing Address - Fax:
Practice Address - Street 1:915 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1162
Practice Address - Country:US
Practice Address - Phone:133-641-4017
Practice Address - Fax:336-608-4040
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5248275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse