Healthcare Provider Details

I. General information

NPI: 1215089073
Provider Name (Legal Business Name): TIMOTHY F CONLEY NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W RIVERSIDE BLVD NORTH TOWNE MALL
ROCKFORD IL
61103-2195
US

IV. Provider business mailing address

1090 W RIVERSIDE BLVD NORTH TOWNE MALL
ROCKFORD IL
61103-2195
US

V. Phone/Fax

Practice location:
  • Phone: 815-877-8600
  • Fax: 815-877-0661
Mailing address:
  • Phone: 815-877-8600
  • Fax: 815-877-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0417
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number426-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: