Provider Demographics
NPI:1518698604
Name:PULLIAM, SARA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15521 REAL ESTATE AVE
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-5327
Mailing Address - Country:US
Mailing Address - Phone:540-289-2273
Mailing Address - Fax:
Practice Address - Street 1:15521 REAL ESTATE AVE
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5327
Practice Address - Country:US
Practice Address - Phone:540-289-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily