Provider Demographics
NPI:1265028575
Name:CONLEY, ERICA D
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
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 1:2555 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:WV
Mailing Address - Zip Code:25266-9243
Mailing Address - Country:US
Mailing Address - Phone:134-565-7477
Mailing Address - Fax:
Practice Address - Street 1:2555 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:WV
Practice Address - Zip Code:25266-9243
Practice Address - Country:US
Practice Address - Phone:304-565-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant