Healthcare Provider Details

I. General information

NPI: 1609828789
Provider Name (Legal Business Name): NANCY CONLEY MD FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18653 WEDGE PKWY SUITE 130
RENO NV
89511-3005
US

IV. Provider business mailing address

18653 WEDGE PKWY SUITE 130
RENO NV
89511-3005
US

V. Phone/Fax

Practice location:
  • Phone: 775-770-7112
  • Fax: 775-770-7113
Mailing address:
  • Phone: 775-770-7112
  • Fax: 775-770-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number11917
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11917
License Number StateNV

VIII. Authorized Official

Name: NANCY G CONLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 775-770-7112