Provider Demographics
NPI:1992008361
Name:GENTILI, LAURA A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:GENTILI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 CHERRY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4402
Mailing Address - Country:US
Mailing Address - Phone:301-916-2858
Mailing Address - Fax:
Practice Address - Street 1:5910 FREDERICK CROSSING LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5112
Practice Address - Country:US
Practice Address - Phone:240-505-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health