Provider Demographics
NPI:1477862407
Name:GENTILLE, EDNA (RN)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:GENTILLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8639 208TH ST
Mailing Address - Street 2:APT 1A
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1686
Mailing Address - Country:US
Mailing Address - Phone:718-217-5662
Mailing Address - Fax:
Practice Address - Street 1:8639 208TH ST
Practice Address - Street 2:APT 1A
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1686
Practice Address - Country:US
Practice Address - Phone:718-217-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY593042OtherRN LICENSE