Individual
MRS. JACQUELINE IMOGENE CONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP CS CCRN
Contact information
Practice address
166 STONERIDGE DRIVE, COLUMBIA, SC 29210
(803) 461-3000
Mailing address
PO BOX 2046, WEST COLUMBIA, SC 29171
(803) 461-3000
(803) 461-4914
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
959
SC
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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