Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 21854 | TN |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71007319A | IN |
NPI | 1023567104 |
---|---|
Provider Name | Jillian Condon |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-2040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 18/09/2020 |