Basic Information
| Provider Information | |||||||||
| NPI: | 1457876534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONDIT | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197761751 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197761751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2017 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5009740 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1457876534 | 05 | NC | MEDICAID |