Vivian L Condello, RN, MS, FNP, IBCLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F332995-1 Issued in NY

Practice address

350 New Campus Dr
Hazen Hall
Brockport, NY 14420-2997

Phone

(585) 395-2414

Fax

(585) 395-2559

NPI assigned

May 14, 2007

Last updated

Feb 4, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State University of New York College at Brockport

  • Student Health Clinic/Center
  • Brockport, NY
  • NPI 1033465539
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1538374129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 CLOONEY DR",
            "city": "HENRIETTA",
            "state": "NY",
            "postal_code": "144678902",
            "telephone_number": "585-334-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 NEW CAMPUS DR",
            "address_2": "HAZEN HALL",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144202997",
            "telephone_number": "585-395-2414",
            "fax_number": "585-395-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDELLO",
        "first_name": "VIVIAN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "RN, MS, FNP, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NY",
            "license": "252168-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F332995-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Anne Cohen, RN
• Lee James Cohen, MS,ATC
• Janell M Coley
• George Collins, DPT
• Community Urgent Center,LLC
• Dena Conley, PA-C
• Timothy Conlon, RPH
• Elizabeth A. Cooley, L.C.S.W.
• Kelly Volkmuth Coon, OTR/L
• Tammy L Cornelius, RDH

• Family Nurse Practitioner in Brockport, NY
• Providers in Brockport, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.