Provider Demographics
NPI:1598904468
Name:CONLEY, SHANNON ROSETTE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:ROSETTE
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 1:13334 CINDY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-8714
Mailing Address - Country:US
Mailing Address - Phone:330-428-5079
Mailing Address - Fax:
Practice Address - Street 1:13334 CINDY ST NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-8714
Practice Address - Country:US
Practice Address - Phone:330-428-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN127180164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse