MEDICARE: DOROTHY MAE CONLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	235051	TX

General Provider Information

NPI Number	:	1104343037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY MAE CONLEY RN

Provider Business Mailing Address
First Line	:	3610 MADISON DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7250
Country	:	US
Telephone Number	:	409-771-2484
Fax Number	:	346-240-4623

Provider Business Practice Location Address
First Line	:	5305 WILMINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-3256
Country	:	US
Telephone Number	:	346-240-4623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/22/2017

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