Gentry, Marisa Vella
Gentry, Marisa Vella is an sole proprietor health care provider with primary practice located at 7033 Saint Andrews Rd Ste 305 , Columbia SC 29212-1181. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Gentry, Marisa Vella can be contacted via phone (803) 936-7480.Contact Information
Primary practice address
7033 Saint Andrews Rd Ste 305
Columbia SC 29212-1181
Phone: (803) 936-7480
Fax: (803) 936-7481
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 18959 | South Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | 18959 | South Carolina |
Profile Details
| NPI number | 1518374586 |
|---|---|
| LBN Legal business name | Gentry, Marisa Vella |
| Credentials | NP-C |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 22nd, 2014 |
| Last updated | Oct 27th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518374586 | NPPES |
| South Carolina | MEDICAID | NP4359 |
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