Provider Demographics
NPI:1730181322
Name:CONLON, MARY CELESTE (FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CELESTE
Last Name:CONLON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2550 ELMS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9844
Mailing Address - Country:US
Mailing Address - Phone:843-302-8840
Mailing Address - Fax:843-818-2188
Practice Address - Street 1:2550 ELMS CENTER RD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-832-8840
Practice Address - Fax:843-818-2188
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX709848363LF0000X
SC448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily