Provider Demographics
NPI:1841672409
Name:GENTRY, ELLEN RACHEL (CRNA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:RACHEL
Last Name:GENTRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:RACHEL
Other - Last Name:SANDIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:111 HILLDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-1806
Mailing Address - Country:US
Mailing Address - Phone:423-843-9252
Mailing Address - Fax:
Practice Address - Street 1:111 HILLDALE DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-1806
Practice Address - Country:US
Practice Address - Phone:423-802-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000149664163WP0200X, 163WC0200X, 163WN0800X
GAGAA-CRNA000992367500000X
TN20658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience