Provider Demographics
NPI:1235643040
Name:CONLEY, MEGAN M (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:BOGEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2001 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1991
Mailing Address - Country:US
Mailing Address - Phone:317-338-2051
Mailing Address - Fax:
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-338-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86081427133V00000X
IN37003189A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered