Provider Demographics
NPI:1164454500
Name:CONDON, NANCY KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHLEEN
Last Name:CONDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER
Mailing Address - Street 2:PSC 827 BOX 345
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617-1000
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER
Practice Address - Street 2:PSC 827 BOX 345
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09617-1000
Practice Address - Country:IT
Practice Address - Phone:314-629-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113925163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator