Healthcare Provider Details

I. General information

NPI: 1912819681
Provider Name (Legal Business Name): HENDRIK C CONDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 NTH 3RD ST APT 9 1113 NTH 3RD ST 9
BISMARCK ND
58501
US

IV. Provider business mailing address

1113 NTH 3RD ST APT ( 1113 NTH 3RD ST
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-989-4973
  • Fax: 701-989-4973
Mailing address:
  • Phone: 701-989-4973
  • Fax: 701-989-4973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: