Healthcare Provider Details

I. General information

NPI: 1386607430
Provider Name (Legal Business Name): ASHLEY LYNN CONNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 3 MILE RD NW SUITE A
WALKER MI
49544-8251
US

IV. Provider business mailing address

1550 3 MILE RD NW
WALKER MI
49544-8251
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-3883
  • Fax:
Mailing address:
  • Phone: 616-887-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAC063882
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: