Provider Demographics
NPI:1730148024
Name:NETTROUR, SANDRA L (PA-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:NETTROUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:N
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:SUITE 2120
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-367-0600
Mailing Address - Fax:412-367-7079
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 2120
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-367-0600
Practice Address - Fax:412-367-7079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000282L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1443065OtherHIGHMARK BLUE CROSS B.S.
PA1443065OtherHIGHMARK BLUE CROSS B.S.
PA140882EA0Medicare ID - Type Unspecified