Provider Demographics
NPI:1932641776
Name:GIBNEY, COURTNEY (CRNA, DNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GIBNEY
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71 W HUBBARD ST
Mailing Address - Street 2:#1712
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 W HUBBARD ST
Practice Address - Street 2:#1712
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4637
Practice Address - Country:US
Practice Address - Phone:616-644-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015125367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered