Healthcare Provider Details

I. General information

NPI: 1295989424
Provider Name (Legal Business Name): JESSIE LOUISE CONDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

130 DIVISION ST
DERBY CT
06418-1326
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-7268
  • Fax:
Mailing address:
  • Phone: 203-732-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number003677
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: