Provider Demographics
NPI:1841054574
Name:GENTRY, VICTORIA (RN, CMM)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:RN, CMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SW 119TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2625
Mailing Address - Country:US
Mailing Address - Phone:405-295-5525
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 119TH ST STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-2625
Practice Address - Country:US
Practice Address - Phone:405-295-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty