Provider Demographics
NPI:1003864240
Name:WILLNER, DEBORAH J (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:WILLNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5569
Mailing Address - Country:US
Mailing Address - Phone:866-871-5737
Mailing Address - Fax:630-522-0843
Practice Address - Street 1:11900 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1200
Practice Address - Country:US
Practice Address - Phone:708-274-4900
Practice Address - Fax:708-274-4949
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085000430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21849Medicare UPIN
IL910750001Medicare PIN