Provider Demographics
NPI:1063535680
Name:GENTRY, ANN B
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:B
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 1:1500 BINNING ROAD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9727
Mailing Address - Country:US
Mailing Address - Phone:513-732-2491
Mailing Address - Fax:
Practice Address - Street 1:371 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45260-0424
Practice Address - Country:US
Practice Address - Phone:513-735-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02656586Medicaid