Provider Demographics
NPI:1669193066
Name:CONDON, JILLIAN ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:CONDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7030 SADDLEBACK RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9218
Mailing Address - Country:US
Mailing Address - Phone:419-367-1138
Mailing Address - Fax:
Practice Address - Street 1:7030 SADDLEBACK RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9218
Practice Address - Country:US
Practice Address - Phone:419-367-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN301646163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN301646OtherOHIO BOARD OF NURSING