Provider Demographics
NPI:1205177219
Name:MCLEAN-GENTRY, VALERIE R
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:R
Last Name:MCLEAN-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 1:5503 RAMBLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1440
Mailing Address - Country:US
Mailing Address - Phone:301-728-6867
Mailing Address - Fax:
Practice Address - Street 1:5503 RAMBLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1440
Practice Address - Country:US
Practice Address - Phone:301-728-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN56999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse