MEDICARE: SIERRA GAINES RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	0001294775	VA

General Provider Information

NPI Number	:	1104573500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA GAINES RN

Provider Business Mailing Address
First Line	:	4008 DARTON CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1180
Country	:	US
Telephone Number	:	804-349-5715
Fax Number	:

Provider Business Practice Location Address
First Line	:	10431 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-5101
Country	:	US
Telephone Number	:	804-349-5715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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