Healthcare Provider Details

I. General information

NPI: 1134183692
Provider Name (Legal Business Name): VIRGINIA GILLELAND A.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

2318 MARTIN LN SW
ROANOKE VA
24015-3812
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-224-1904
Mailing address:
  • Phone: 540-354-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024144140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: