Provider Demographics
NPI:1487938320
Name:OPALACZ, COURTNEY HILLYER (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:HILLYER
Last Name:OPALACZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:HILLYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3858
Mailing Address - Country:US
Mailing Address - Phone:980-487-1400
Mailing Address - Fax:
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-812-5120
Practice Address - Fax:717-741-3075
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055130363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01318826Medicare PIN
PA329591FLTMedicare PIN