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General NPI Number Information
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NPI Number | 1750997318
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Entity Type | Individual
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Provider Name | SARA J ELLIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 1963 2ND ST
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City | RICHLANDS
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State | VA
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Zip | 24641-2303
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Country | US
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Telephone | 276-596-9181
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Fax | 276-596-9182
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Provider Business Mailing Address
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Address Line | 660 STAR ST
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City | POUNDING MILL
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State | VA
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Zip | 24637-4309
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Country | US
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Telephone | 276-202-8995
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024180178
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License Number State | VA
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