Provider Demographics
NPI:1396412953
Name:CONDON, AMANDA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:CONDON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8741 JERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7342
Mailing Address - Country:US
Mailing Address - Phone:706-318-3023
Mailing Address - Fax:
Practice Address - Street 1:6930 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2312
Practice Address - Country:US
Practice Address - Phone:956-728-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife