Provider Demographics
NPI:1477790020
Name:CONLEY-MORELLI, DAWN MICHELE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:CONLEY-MORELLI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 CENTER POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027
Mailing Address - Country:US
Mailing Address - Phone:315-766-6729
Mailing Address - Fax:315-303-5892
Practice Address - Street 1:8855 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1421
Practice Address - Country:US
Practice Address - Phone:315-766-6729
Practice Address - Fax:315-303-5892
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY515009-1163W00000X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03074935Medicaid