Provider Demographics
NPI:1225727340
Name:CONLEY, LORI (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 MONSON RD
Mailing Address - Street 2:
Mailing Address - City:EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13335-2116
Mailing Address - Country:US
Mailing Address - Phone:631-879-7224
Mailing Address - Fax:
Practice Address - Street 1:438 MONSON RD
Practice Address - Street 2:
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13335-2116
Practice Address - Country:US
Practice Address - Phone:631-879-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283489-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse