Provider Demographics
NPI:1407829302
Name:CONLON, DEBORAH KAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:CONLON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14067 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430
Mailing Address - Country:US
Mailing Address - Phone:810-714-5174
Mailing Address - Fax:810-714-5174
Practice Address - Street 1:190 E STATE ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9144
Practice Address - Country:US
Practice Address - Phone:810-639-2056
Practice Address - Fax:810-639-3167
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704164104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine