Provider Demographics
NPI:1902001001
Name:SETZER, SANDRA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:SETZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:S
Other - Last Name:DANIELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 N CHURCH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1035
Mailing Address - Country:US
Mailing Address - Phone:336-663-4900
Mailing Address - Fax:336-663-4920
Practice Address - Street 1:1126 N CHURCH ST STE 103
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1035
Practice Address - Country:US
Practice Address - Phone:336-663-4900
Practice Address - Fax:336-663-4920
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10490363A00000X, 363AS0400X
GA003106363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA637158OtherBCBS ID#
GA199990082BMedicaid
GA199990082BMedicaid