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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2150 W 117TH ST STE 1238
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-1641
Mailing Address - Country:US
Mailing Address - Phone:216-477-0071
Mailing Address - Fax:216-957-8518
Practice Address - Street 1:2150 W 117TH ST STE 1238
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-1641
Practice Address - Country:US
Practice Address - Phone:216-477-0071
Practice Address - Fax:216-957-8518
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
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