Provider Demographics
NPI:1184690760
Name:CONDON, MYRTH CRYSTAL (NP)
Entity type:Individual
Prefix:
First Name:MYRTH
Middle Name:CRYSTAL
Last Name:CONDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MYRTH
Other - Middle Name:CRYSTAL
Other - Last Name:SHERRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:622W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1329
Mailing Address - Country:US
Mailing Address - Phone:906-387-4614
Mailing Address - Fax:906-387-4727
Practice Address - Street 1:1500 SANDPOINT RD
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1406
Practice Address - Country:US
Practice Address - Phone:906-387-4110
Practice Address - Fax:906-387-2825
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704173840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704173840OtherSTATE LICENSE
MI4704173840OtherSTATE LICENSE