Provider Demographics
NPI:1346217684
Name:CONLEY, GRETCHEN V (ANP)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:V
Last Name:CONLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:V
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:5230 E STOP 11 RD STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6399
Practice Address - Country:US
Practice Address - Phone:317-865-5904
Practice Address - Fax:317-865-5321
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28094532A163W00000X
IN71001092A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN13244XMedicare ID - Type Unspecified
INP39596Medicare UPIN