Provider Demographics
NPI:1336109834
Name:WILLNER, COURTNEY M (DO)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:M
Last Name:WILLNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:501 W OTTERMAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2126
Mailing Address - Country:US
Mailing Address - Phone:724-850-6933
Mailing Address - Fax:724-836-6825
Practice Address - Street 1:121 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1068
Practice Address - Country:US
Practice Address - Phone:724-832-4626
Practice Address - Fax:724-832-4668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012207207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019098140001Medicaid
H71271Medicare UPIN
063033Medicare ID - Type Unspecified