Provider Demographics
NPI:1457830564
Name:CONLEY, TANISHA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:NICOLE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26292 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1907
Mailing Address - Country:US
Mailing Address - Phone:734-239-5103
Mailing Address - Fax:
Practice Address - Street 1:26292 W HILLS DR
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1907
Practice Address - Country:US
Practice Address - Phone:734-239-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112877164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse