Provider Demographics
NPI:1407977234
Name:CULIBERK, JOHN L (AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:CULIBERK
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:L
Other - Last Name:CULIBERK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:1 FRONTENAC PL
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1709
Mailing Address - Country:US
Mailing Address - Phone:618-779-6379
Mailing Address - Fax:
Practice Address - Street 1:400 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2028
Practice Address - Country:US
Practice Address - Phone:618-498-6402
Practice Address - Fax:618-498-8411
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041310653163W00000X
IL209022246363LG0600X
MO2020035384363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse