Provider Demographics
NPI:1134761851
Name:GENTRY, OLUWASEUN HELEN
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:HELEN
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1717
Mailing Address - Country:US
Mailing Address - Phone:240-217-0834
Mailing Address - Fax:
Practice Address - Street 1:3317 HAYES ST
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1717
Practice Address - Country:US
Practice Address - Phone:240-217-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14634374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide