Healthcare Provider Details

I. General information

NPI: 1346689882
Provider Name (Legal Business Name): PRISCILLA CONLEY RN'MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 BLACKHAWK CIR
CINCINNATI OH
45240-1405
US

IV. Provider business mailing address

11905 BLACKHAWK CIR
CINCINNATI OH
45240-1405
US

V. Phone/Fax

Practice location:
  • Phone: 513-476-2233
  • Fax: 859-491-2507
Mailing address:
  • Phone: 513-476-2233
  • Fax: 859-491-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN170664
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN170664
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN170664
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN170664
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN170664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: