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General NPI Number Information
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NPI Number | 1407829302
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Entity Type | Individual
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Provider Name | DEBORAH KAY CONLON NP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 190 E STATE ST
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City | MONTROSE
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State | MI
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Zip | 48457-9144
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Country | US
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Telephone | 810-639-2056
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Fax | 810-639-3167
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Provider Business Mailing Address
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Address Line | 14067 WOODVIEW DR
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City | FENTON
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State | MI
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Zip | 48430
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Country | US
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Telephone | 810-714-5174
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Fax | 810-714-5174
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4704164104
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License Number State | MI
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