Healthcare Provider Details

I. General information

NPI: 1891137725
Provider Name (Legal Business Name): ELIZABETH ERIN CONN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH LEPLEY CONN NP

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 200
MODESTO CA
95350-4438
US

IV. Provider business mailing address

PO BOX 976 23289 JOAQUIN GULLY ROAD
TWAIN HARTE CA
95383
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax:
Mailing address:
  • Phone: 949-547-8718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: