Provider Demographics
NPI:1336873769
Name:GILMER, SARAH BETH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:GILMER
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 1:5618 MIDDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2814
Mailing Address - Country:US
Mailing Address - Phone:440-669-7900
Mailing Address - Fax:
Practice Address - Street 1:870 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1219
Practice Address - Country:US
Practice Address - Phone:440-415-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031776363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner