Healthcare Provider Details

I. General information

NPI: 1043420185
Provider Name (Legal Business Name): BEVERLY LYNN CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6037 PRICE AVE
MCCLELLAN CA
95652-2400
US

IV. Provider business mailing address

5609 RAFFERTY AVE
MCCLELLAN CA
95652-2412
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7568
  • Fax: 916-561-7566
Mailing address:
  • Phone: 530-748-9018
  • Fax: 916-561-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: