Provider Demographics
NPI:1467032748
Name:CONLEY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LAKEVIEW DR APT 301A
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1653
Mailing Address - Country:US
Mailing Address - Phone:304-494-2603
Mailing Address - Fax:
Practice Address - Street 1:824 LAKEVIEW DR APT 301A
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1653
Practice Address - Country:US
Practice Address - Phone:304-494-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant