Provider Demographics
NPI:1972833309
Name:CONDON, NICKI LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NICKI
Middle Name:LYNN
Last Name:CONDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 BURGOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-2670
Mailing Address - Country:US
Mailing Address - Phone:518-955-6404
Mailing Address - Fax:
Practice Address - Street 1:1232 BURGOYNE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-2670
Practice Address - Country:US
Practice Address - Phone:518-955-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291041-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse