Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 1133 | OH |
NPI | 1801001029 |
---|---|
Provider Name | Vivian A Conde |
First Address | Grafton, OH 44044-0228 |
Second Address | Lagrange, OH 44050-9513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
341605134 | COMMERCIAL INSURANCE (01) | OH |
341605134005 | MEDICAL MUTUAL OF OHIO (01) | OH |
341605134-01 | BWC (01) | OH |