Provider Demographics
NPI:1578522546
Name:MCBRIDE CONLEY, EUNICE (LPN)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:MCBRIDE 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 1:4227 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1648
Mailing Address - Country:US
Mailing Address - Phone:414-449-1089
Mailing Address - Fax:414-449-9884
Practice Address - Street 1:4227 N 40TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1648
Practice Address - Country:US
Practice Address - Phone:414-449-1089
Practice Address - Fax:414-449-9884
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38286700OtherLPN RCS