Provider Demographics
NPI:1003437799
Name:KIBILKA, ALISON JEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JEANNE
Last Name:KIBILKA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23273 2525 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-8921
Mailing Address - Country:US
Mailing Address - Phone:815-878-4817
Mailing Address - Fax:
Practice Address - Street 1:925 WEST ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2757
Practice Address - Country:US
Practice Address - Phone:815-780-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021378367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered