Provider Demographics
NPI:1124843933
Name:FETTEROLF, SARAH LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:FETTEROLF
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 1:33 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MILLMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17845-7012
Mailing Address - Country:US
Mailing Address - Phone:570-713-8634
Mailing Address - Fax:
Practice Address - Street 1:7055 WESTBRANCH HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6808
Practice Address - Country:US
Practice Address - Phone:570-524-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant