Healthcare Provider Details

I. General information

NPI: 1841918398
Provider Name (Legal Business Name): BRIDGET CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 G ST
SOUTH SIOUX CITY NE
68776-3467
US

IV. Provider business mailing address

4230 WAR EAGLE DR
SIOUX CITY IA
51109-1700
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-2433
  • Fax:
Mailing address:
  • Phone: 712-224-4308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number65556
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: