Provider Demographics
NPI:1154171460
Name:CONDON, STEPHANIE KAY (CNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:CONDON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E 2ND ST APT 141
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-2937
Mailing Address - Country:US
Mailing Address - Phone:308-353-1986
Mailing Address - Fax:
Practice Address - Street 1:113 MAKOCHMNI
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-5802
Practice Address - Country:US
Practice Address - Phone:308-464-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH12874174OtherCERTIFIED NURSES ASSISTANT