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General NPI Number Information
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NPI Number | 1063193126
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Entity Type | Individual
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Provider Name | SARA JANELLE WILSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 600 PETER JEFFERSON PKWY STE 310
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8836
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Country | US
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Telephone | 434-977-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 VANTAGE WAY APT 111
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City | CROZET
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State | VA
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Zip | 22932-3197
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Country | US
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Telephone | 540-820-2061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110009445
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License Number State | VA
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