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Individual

SARA N GILLIS

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
CPNP

Contact information

Practice address
21 HIGHLAND AVE SE, STE 100, ROANOKE, VA 24013-2218
(540) 344-9213
(540) 345-7559
Mailing address
21 HIGHLAND AVE SE, STE 100, ROANOKE, VA 24013-2218
(540) 344-9213
(540) 345-7559

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0001137848
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
54088505612
JOHN DEERE
VA
01
5657671
AETNA
VA
Enumeration date
06/09/2005
Last updated
07/08/2007
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