Provider Demographics
NPI:1467109348
Name:PILLER, MARY ETTA (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ETTA
Last Name:PILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2447
Mailing Address - Country:US
Mailing Address - Phone:941-303-1282
Mailing Address - Fax:
Practice Address - Street 1:2291 EVELYN BYRD AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5424
Practice Address - Country:US
Practice Address - Phone:540-434-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018686367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife