Provider Demographics
NPI:1730667437
Name:GENTRY, EVELENA (LVN)
Entity Type:Individual
Prefix:MS
First Name:EVELENA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EVELENA GENTRY
Mailing Address - Street 2:830 TRINITY LANE
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-4530
Mailing Address - Country:US
Mailing Address - Phone:870-718-4390
Mailing Address - Fax:
Practice Address - Street 1:EVELENA GENTRY
Practice Address - Street 2:830 TRINITY LANE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-4530
Practice Address - Country:US
Practice Address - Phone:870-718-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL46754164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse