Provider Demographics
NPI:1295380160
Name:CONERY, PETER WILLIAM (LPN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:CONERY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BERNE ALTAMONT ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009
Mailing Address - Country:US
Mailing Address - Phone:518-641-2807
Mailing Address - Fax:
Practice Address - Street 1:1615 BERNE ALTAMONT ROAD
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009
Practice Address - Country:US
Practice Address - Phone:518-641-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327819164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse