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General NPI Number Information
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NPI Number | 1154836187
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Entity Type | Individual
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Provider Name | COURTNEY O'CONNOR LEIBY
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 736 PINE ST UNIT C
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4005
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Country | US
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Telephone | 267-322-7705
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Fax | 267-322-7705
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Provider Business Mailing Address
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Address Line | 734 N 19TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 120958
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License Number State | PA
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