Provider Demographics
NPI:1417263989
Name:CONLEY, AMANDA DRUMMOND (PNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DRUMMOND
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SELBY
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 MARION RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1406
Mailing Address - Country:US
Mailing Address - Phone:508-295-8622
Mailing Address - Fax:508-295-4909
Practice Address - Street 1:53 MARION RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1406
Practice Address - Country:US
Practice Address - Phone:508-295-8622
Practice Address - Fax:508-295-4909
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266228363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics