Provider Demographics
NPI:1134598899
Name:CONDREY, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:CONDREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 VOLKER HL
Mailing Address - Street 2:SUITE M220
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:205-934-3795
Mailing Address - Fax:205-975-8991
Practice Address - Street 1:1601 4TH AVE S
Practice Address - Street 2:SUITE M220
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1723
Practice Address - Country:US
Practice Address - Phone:205-638-9072
Practice Address - Fax:205-975-7080
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-055840363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-055840OtherBOARD OF NURSING