Provider Demographics
NPI:1023174844
Name:GENTRY-CALVO, JENNIFER AMY (NMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMY
Last Name:GENTRY-CALVO
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:42323 N VISION WAY
Mailing Address - Street 2:STE 108
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1490
Mailing Address - Country:US
Mailing Address - Phone:623-551-0027
Mailing Address - Fax:623-551-1768
Practice Address - Street 1:42323 N VISION WAY
Practice Address - Street 2:STE 108
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-1490
Practice Address - Country:US
Practice Address - Phone:623-551-0027
Practice Address - Fax:623-551-1768
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-916175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath