Basic Information
| Provider Information | |||||||||
| NPI: | 1366915480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASSAWAY | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ALLISON | ||||||||
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| Credential: | APRN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2817 REILLY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283106438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 214561 | NC | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | 5011770 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.