Etzel, Blaine C

Etzel, Blaine C is an individual health care provider with primary practice located at 100 Kellie Dr , Smithfield NC 27577-9444. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Etzel, Blaine C can be contacted via phone (919) 220-5255.

Contact Information

Primary practice address
100 Kellie Dr Smithfield NC 27577-9444
Phone: (919) 220-5255
Fax: (919) 313-1276
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA10004050 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 299 Montana
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0010-10604 North Carolina

Profile Details

NPI number 1881686590
LBN Legal business name Etzel, Blaine C
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2005
Last updated Sep 23rd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881686590 NPPES
North Carolina Other 0010-10604 NORTH CAROLINA MEDICAL BOARD

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