Provider Demographics
NPI:1942942479
Name:SETZKORN, LAUREN ELISE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ELISE
Last Name:SETZKORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 COUNTRYSIDE DR N
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4561
Mailing Address - Country:US
Mailing Address - Phone:937-479-7324
Mailing Address - Fax:
Practice Address - Street 1:803 W MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2796
Practice Address - Country:US
Practice Address - Phone:419-996-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007494RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant