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General NPI Number Information
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NPI Number | 1508860289
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Entity Type | Individual
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Provider Name | SARA N GILLIS CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21 HIGHLAND AVE SE STE 100
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City | ROANOKE
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State | VA
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Zip | 24013-2218
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Country | US
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Telephone | 540-344-9213
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Fax | 540-345-7559
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Provider Business Mailing Address
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Address Line | 21 HIGHLAND AVE SE STE 100
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City | ROANOKE
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State | VA
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Zip | 24013-2218
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Country | US
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Telephone | 540-344-9213
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Fax | 540-345-7559
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0001137848
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License Number State | VA
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