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NPI Code Detail

MEDICARE: MRS. MARY LEE CONROY

MEDICARE: MRS. MARY LEE CONROY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2174400000XSpecialist

General Provider Information

NPI Number : 1285815688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY LEE CONROY
Provider Business Mailing Address
First Line : 7759 SE 72ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-7921
Country : US
Telephone Number : 503-788-4500
Fax Number : 503-788-4506
Provider Business Practice Location Address
First Line : 7759 SE 72ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-7921
Country : US
Telephone Number : 503-788-4500
Fax Number : 503-788-4506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2007
Last Update Date : 04/05/2019

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