Healthcare Provider Details

I. General information

NPI: 1578407599
Provider Name (Legal Business Name): AUTUMN CONLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S HIGLEY RD STE 104-1150
GILBERT AZ
85296-4795
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104-1150
GILBERT AZ
85296-4795
US

V. Phone/Fax

Practice location:
  • Phone: 480-359-7703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number335320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: