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General NPI Number Information
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NPI Number | 1407977234
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Entity Type | Individual
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Provider Name | JOHN L CULIBERK AGNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 400 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2028
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Country | US
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Telephone | 618-498-6402
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Fax | 618-498-8411
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Provider Business Mailing Address
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Address Line | 1 FRONTENAC PL
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City | GODFREY
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State | IL
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Zip | 62035-1709
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Country | US
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Telephone | 618-779-6379
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041310653
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209022246
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2020035384
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License Number State | MO
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