Individual
SARA L NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002022
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020002600
FEDERAL BLACK LUNG
VA
Enumeration date
09/20/2005
Last updated
05/13/2011
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