Healthcare Provider Details

I. General information

NPI: 1902001001
Provider Name (Legal Business Name): SANDRA JANE SETZER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA S DANIELL

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 103
GREENSBORO NC
27401-1035
US

IV. Provider business mailing address

1126 N CHURCH ST STE 103
GREENSBORO NC
27401-1035
US

V. Phone/Fax

Practice location:
  • Phone: 336-663-4900
  • Fax: 336-663-4920
Mailing address:
  • Phone: 336-663-4900
  • Fax: 336-663-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10490
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003106
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-10490
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: