Provider Demographics
NPI:1093326159
Name:CONGER, CHARLAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARLAINE
Middle Name:
Last Name:CONGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKE MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-8639
Mailing Address - Country:US
Mailing Address - Phone:803-292-9250
Mailing Address - Fax:
Practice Address - Street 1:105 LAKE MURRAY DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-8639
Practice Address - Country:US
Practice Address - Phone:803-292-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily