Provider Demographics
NPI:1104220276
Name:CONLEY, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 EASTSHORE PL
Mailing Address - Street 2:RENO
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4318
Mailing Address - Country:US
Mailing Address - Phone:775-677-8470
Mailing Address - Fax:
Practice Address - Street 1:2708 EASTSHORE PL
Practice Address - Street 2:RENO
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4318
Practice Address - Country:US
Practice Address - Phone:775-677-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XMedicaid