1366482291 NPI number — MS. CHRISTINE MARIE CONDE LVN

Table of content: MS. CHRISTINE MARIE CONDE LVN (NPI 1366482291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366482291 NPI number — MS. CHRISTINE MARIE CONDE LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDE
Provider First Name:
CHRISTINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEAGLE
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366482291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36000 DARNALL LOOP
Provider Second Line Business Mailing Address:
CARL R DARNALL ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-288-8048
Provider Business Mailing Address Fax Number:
254-288-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36000 DARNALL LOOP
Provider Second Line Business Practice Location Address:
CARL R DARNALL ARMY MED CTR GEN SURGERY UROLOGY CLINIC
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-288-8048
Provider Business Practice Location Address Fax Number:
254-288-8875
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  184628 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)