Provider Demographics
NPI:1043420185
Name:CONLEY, BEVERLY LYNN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 RAFFERTY AVE
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2412
Mailing Address - Country:US
Mailing Address - Phone:530-748-9018
Mailing Address - Fax:916-561-7566
Practice Address - Street 1:6037 PRICE AVE
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2400
Practice Address - Country:US
Practice Address - Phone:916-561-7568
Practice Address - Fax:916-561-7566
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider