1033843248 NPI number — HOLLY KATHLEEN CONDIE APNP

Table of content: HOLLY KATHLEEN CONDIE APNP (NPI 1033843248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033843248 NPI number — HOLLY KATHLEEN CONDIE APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDIE
Provider First Name:
HOLLY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NYQUIST
Provider Other First Name:
HOLLY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033843248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1866
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-1866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-445-7210
Provider Business Mailing Address Fax Number:
920-846-8313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E HIGHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCONTO FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54154-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-846-3092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2022

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: 163W00000X , with the licence number:  247775-30 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 13061-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13061-33 . This is a "WI APNP LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: F06220927 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS" identifier . This identifiers is of the category "OTHER".