Provider Demographics
NPI:1417292996
Name:CONLEY, ANDREA L (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:CONLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11842 ROCK LANDING DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4437
Mailing Address - Country:US
Mailing Address - Phone:757-595-9905
Mailing Address - Fax:757-595-5377
Practice Address - Street 1:11842 ROCK LANDING DR
Practice Address - Street 2:SUITE 115
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4437
Practice Address - Country:US
Practice Address - Phone:757-595-9905
Practice Address - Fax:757-595-5377
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024170458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024170458OtherVIRGINIA LICENSE