Healthcare Provider Details

I. General information

NPI: 1083416556
Provider Name (Legal Business Name): VLADA CONDREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 W WASHINGTON ST
LINCOLN NE
68522-4465
US

IV. Provider business mailing address

2910 W WASHINGTON ST
LINCOLN NE
68522-4465
US

V. Phone/Fax

Practice location:
  • Phone: 865-240-1370
  • Fax:
Mailing address:
  • Phone: 865-240-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number149836
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: