Provider Demographics
NPI:1235334640
Name:CONDER, SARAH ELAINE (DI)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELAINE
Last Name:CONDER
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 50
Mailing Address - Street 2:
Mailing Address - City:OAKLAND CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47660-9605
Mailing Address - Country:US
Mailing Address - Phone:812-749-4171
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 50
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-9605
Practice Address - Country:US
Practice Address - Phone:812-749-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor