Provider Demographics
NPI:1336688175
Name:WITTROCK, COURTNEY MAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MAE
Last Name:WITTROCK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-229-5142
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-229-5142
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-03-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical