Provider Demographics
NPI:1750964573
Name:GENTRY, RALANDA SHANTEL (CNA)
Entity type:Individual
Prefix:
First Name:RALANDA
Middle Name:SHANTEL
Last Name:GENTRY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3046
Mailing Address - Country:US
Mailing Address - Phone:919-636-2465
Mailing Address - Fax:
Practice Address - Street 1:1309 HUDSON AVE APT C11
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7615
Practice Address - Country:US
Practice Address - Phone:919-636-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC257966376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide