Individual
DEBRA COPELAND SIZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4618 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3520
(336) 716-2255
(336) 716-9258
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9258
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000101030
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7330736
AETNA
—
01
—
94719
MEDCOST
—
01
—
970025245
RR MEDICARE
—
Enumeration date
12/13/2005
Last updated
10/21/2010
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