Provider Demographics
NPI:1649770637
Name:CONDON, ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CONDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PINEFIELDS LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3632
Mailing Address - Country:US
Mailing Address - Phone:207-740-5723
Mailing Address - Fax:
Practice Address - Street 1:16 COMMERCE PLZ STE 3A
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1562
Practice Address - Country:US
Practice Address - Phone:207-377-2111
Practice Address - Fax:207-624-3845
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily