Doctor Name: | MS. CHARLENE THERESA CONDOLL |
NPI Number: | 1265748065 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 722770 |
Business Practice Address: | 1111 W Adoue St Alvin, TX - 775112718 |
Business Phone Number: | 2818241480 |
Business Fax Number: | 2818241469 |
Mailing Address: | 2702 Calico Creek Ln, PEARLAND |
State: | TX |
Postal Code: | 775846504 |
Phone Number: | 7134368304 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2010 |
NPI Last Update Date: | 08/31/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 722770 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |