Provider Demographics
NPI:1679311617
Name:BIBO, COURTNEY GARLAND (DNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GARLAND
Last Name:BIBO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3456
Mailing Address - Country:US
Mailing Address - Phone:309-558-5459
Mailing Address - Fax:
Practice Address - Street 1:306 46TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4281
Practice Address - Country:US
Practice Address - Phone:309-796-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily