Provider Demographics
NPI:1801541750
Name:KONDRK, HANNAH (LE)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KONDRK
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 N PECOS RD STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7336
Mailing Address - Country:US
Mailing Address - Phone:702-574-3845
Mailing Address - Fax:
Practice Address - Street 1:62 N PECOS RD STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7336
Practice Address - Country:US
Practice Address - Phone:702-574-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVE-45205374700000X
E-45305374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE-45305OtherELECTROLYSIS OUT OF NETWORK PROVIDER