Healthcare Provider Details

I. General information

NPI: 1588574321
Provider Name (Legal Business Name): KOREN ELAINE CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

620 KINNAMON LN
CHILLICOTHEE OH
45601-3919
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 740-637-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberR8870766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: