Provider Demographics
NPI:1710106943
Name:KONDRACKI, JENNIFER ELIZABETH (RN,IBCLC,LNC)
Entity Type:Individual
Prefix:MR
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:KONDRACKI
Suffix:
Gender:F
Credentials:RN,IBCLC,LNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4607
Mailing Address - Country:US
Mailing Address - Phone:410-793-5120
Mailing Address - Fax:
Practice Address - Street 1:1230 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4607
Practice Address - Country:US
Practice Address - Phone:410-793-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175401163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health