MEDICARE: MARY ELIZABETH CONLEY NP

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	363L00000X	Nurse Practitioner	142369	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP2350	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396786489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH CONLEY NP

Provider Business Mailing Address
First Line	:	225 CRANBERRY HWY
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-3255
Country	:	US
Telephone Number	:	508-255-8825
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 CRANBERRY HWY
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-3255
Country	:	US
Telephone Number	:	508-255-8825
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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