Provider Demographics
NPI:1922707819
Name:RIDGEWAY, GENTRY (RN)
Entity Type:Individual
Prefix:
First Name:GENTRY
Middle Name:
Last Name:RIDGEWAY
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 1:1547 UPCHURCH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8017
Mailing Address - Country:US
Mailing Address - Phone:706-540-3527
Mailing Address - Fax:
Practice Address - Street 1:400 US 70 HWY E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4049
Practice Address - Country:US
Practice Address - Phone:919-350-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC299546163W00000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163W00000XNursing Service ProvidersRegistered Nurse