Healthcare Provider Details

I. General information

NPI: 1780538488
Provider Name (Legal Business Name): EMILY CONDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

3555 GRANDVIEW PKWY APT 121
BIRMINGHAM AL
35243-2088
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-190307
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: