Healthcare Provider Details

I. General information

NPI: 1174557755
Provider Name (Legal Business Name): RICHARD SCOTT CONLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOLDIER CREEK ROAD
ROSEBUD SD
57570
US

IV. Provider business mailing address

PO BOX 773523
EAGLE RIVER AK
99577-3523
US

V. Phone/Fax

Practice location:
  • Phone: 605-747-2231
  • Fax:
Mailing address:
  • Phone: 907-622-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number256
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: