Provider Demographics
NPI:1033843248
Name:CONDIE, HOLLY KATHLEEN (APNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KATHLEEN
Last Name:CONDIE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:K
Other - Last Name:NYQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1866
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-846-8313
Practice Address - Street 1:107 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1002
Practice Address - Country:US
Practice Address - Phone:920-846-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247775-30163W00000X
WI13061-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13061-33OtherWI APNP LICENSE
F06220927OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
F06220927OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS