MEDICARE: DANETTE B CONDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1891817771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANETTE B CONDON

Provider Business Mailing Address
First Line	:	HC 64 BOX 291
Second Line	:
City	:	HILLSBORO
State	:	WV
Zip	:	24946-9728
Country	:	US
Telephone Number	:	304-653-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 64 BOX 291
Second Line	:
City	:	HILLSBORO
State	:	WV
Zip	:	24946-9728
Country	:	US
Telephone Number	:	304-653-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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Directions to “ DANETTE B CONDON ” Practice Location

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