1457876534 NPI number — BRIDGET FRANCES CONDIT FNP

Table of content: BRIDGET FRANCES CONDIT FNP (NPI 1457876534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457876534 NPI number — BRIDGET FRANCES CONDIT FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDIT
Provider First Name:
BRIDGET
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457876534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 WILKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-7268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-776-6000
Provider Business Mailing Address Fax Number:
919-776-1751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2412 WILKINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-7268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-776-6000
Provider Business Practice Location Address Fax Number:
919-776-1751
Provider Enumeration Date:
08/09/2017

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: 363LF0000X , with the licence number:  5009740 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1457876534 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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