Provider Demographics
NPI:1720751803
Name:CONDREY, CHLOE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ELIZABETH
Last Name:CONDREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:ELIABETH
Other - Last Name:WHITEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NABB
Mailing Address - Street 1:3685 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5211
Mailing Address - Country:US
Mailing Address - Phone:025-590-2204
Mailing Address - Fax:
Practice Address - Street 1:3685 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5211
Practice Address - Country:US
Practice Address - Phone:402-559-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1720751803Medicaid