Provider Demographics
NPI:1144794181
Name:LILLER, SARAH G
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:G
Last Name:LILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VALLEY VIEW STREET, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-9205
Mailing Address - Country:US
Mailing Address - Phone:304-257-9785
Mailing Address - Fax:304-257-9790
Practice Address - Street 1:10 VALLEY VIEW STREET, SUITE 101
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9205
Practice Address - Country:US
Practice Address - Phone:304-257-9785
Practice Address - Fax:304-257-9790
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2351363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty