MEDICARE: MS. MARY CELESTE CONLON FNP

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	363LF0000X	Family Nurse Practitioner	709848	TX
2	363LF0000X	Family Nurse Practitioner	448	SC

General Provider Information

NPI Number	:	1730181322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CELESTE CONLON FNP

Provider Business Mailing Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-302-8840
Fax Number	:	843-818-2188

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-832-8840
Fax Number	:	843-818-2188

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/12/2022

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