Provider Demographics
NPI:1922525898
Name:CELANI, COURTNEY MARIE (MSN,CPNP-AC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:CELANI
Suffix:
Gender:F
Credentials:MSN,CPNP-AC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARIE
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CCRN
Mailing Address - Street 1:225 E CHICAGO AVE # 22
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-4240
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 22
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING IL LICENSE