Provider Demographics
NPI:1083263446
Name:ETTER, JADE ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALEXANDRA
Last Name:ETTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-263-0629
Mailing Address - Fax:717-263-7105
Practice Address - Street 1:835 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4220
Practice Address - Country:US
Practice Address - Phone:717-263-0629
Practice Address - Fax:717-263-7105
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061033363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical