Provider Demographics
NPI:1538314976
Name:CONDICT, EDITH A (CRNP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:A
Last Name:CONDICT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1601
Mailing Address - Country:US
Mailing Address - Phone:570-724-7100
Mailing Address - Fax:570-724-1501
Practice Address - Street 1:1B MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1601
Practice Address - Country:US
Practice Address - Phone:570-724-7100
Practice Address - Fax:570-724-1501
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP009991OtherCRNP LICENSE NUMBER
PA008829OtherCRNP PRESCRIPTIVE AUTHORITY NUMBER