MEDICARE: RAELEIGH SWINDELL CONNER

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	163W00000X	Registered Nurse	RN297011	GA

General Provider Information

NPI Number	:	1407711732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAELEIGH SWINDELL CONNER

Provider Business Mailing Address
First Line	:	122 SOUTH ZETTEROWER AVENUE
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 SOUTH ZETTEROWER AVENUE
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458
Country	:	US
Telephone Number	:	912-259-9991
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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