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General NPI Number Information
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NPI Number | 1033908827
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Entity Type | Individual
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Provider Name | JEANETTE CONLEY
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Gender |
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1620 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3801
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Country | US
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Telephone | 312-942-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4609 S LAMON AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2032
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Country | US
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Telephone | 773-896-6148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 041557180
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License Number State | IL
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