Provider Demographics
NPI:1457708141
Name:FITTERER, COURTENAY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTENAY
Middle Name:LYNN
Last Name:FITTERER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTENAY
Other - Middle Name:LYNN
Other - Last Name:DUDZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7447 W. TALCOTT AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-763-3808
Mailing Address - Fax:773-763-2885
Practice Address - Street 1:7447 W. TALCOTT AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-763-3808
Practice Address - Fax:773-763-2885
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085005667OtherSTATE LICENSE