MEDICARE: COURTNEY CONLAN

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	163WP0200X	Pediatric Registered Nurse	95198425	CA

General Provider Information

NPI Number	:	1528871787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CONLAN

Provider Business Mailing Address
First Line	:	4079 FARQUHAR AVE
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3797
Country	:	US
Telephone Number	:	408-489-6083
Fax Number	:

Provider Business Practice Location Address
First Line	:	4079 FARQUHAR AVE
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3797
Country	:	US
Telephone Number	:	408-489-6083
Fax Number	:

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

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	01/30/2025

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Directions to “ COURTNEY CONLAN ” Practice Location

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