Provider Demographics
NPI:1750876405
Name:GILLON, SARAH CROWGEY
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CROWGEY
Last Name:GILLON
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 1:310 S. 1ST ST. APT. 500
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:919-922-6289
Mailing Address - Fax:
Practice Address - Street 1:11120 NORTH FWY STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1029
Practice Address - Country:US
Practice Address - Phone:281-875-1800
Practice Address - Fax:281-875-1807
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017502363L00000X
TXAP141377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner