Provider Demographics
NPI:1215120985
Name:MARILLA, SHEREE WELLS (FNP)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:WELLS
Last Name:MARILLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:835 WOODLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1586
Practice Address - Country:US
Practice Address - Phone:276-694-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily