Provider Demographics
NPI:1699832105
Name:CONDELLONE, JOANN (CNM, RNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CONDELLONE
Suffix:
Gender:F
Credentials:CNM, RNP
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, RNP
Mailing Address - Street 1:HC 71 BOX 169A
Mailing Address - Street 2:
Mailing Address - City:HUSTONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17229-9403
Mailing Address - Country:US
Mailing Address - Phone:814-448-2029
Mailing Address - Fax:
Practice Address - Street 1:2613 8TH AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2000
Practice Address - Country:US
Practice Address - Phone:814-942-6771
Practice Address - Fax:814-942-5494
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003811G363LX0001X
PAMW008310L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1451937Medicaid
PA124051Medicare ID - Type UnspecifiedMEDICARE
PA1451937Medicaid