Healthcare Provider Details

I. General information

NPI: 1083420251
Provider Name (Legal Business Name): PERRY CONLEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 N CHURCH ST
GREENSBORO NC
27405-3657
US

IV. Provider business mailing address

1214 WILLOW BROOK CT
MEBANE NC
27302-8364
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax:
Mailing address:
  • Phone: 727-946-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number282390
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: