Provider Demographics
NPI:1649742206
Name:CONERLY, NIANI KALIFA (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:NIANI
Middle Name:KALIFA
Last Name:CONERLY
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10441 LAKEWOOD BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2871
Mailing Address - Country:US
Mailing Address - Phone:562-869-1089
Mailing Address - Fax:714-676-3683
Practice Address - Street 1:10441 LAKEWOOD BLVD STE B
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2871
Practice Address - Country:US
Practice Address - Phone:562-869-1089
Practice Address - Fax:714-676-3683
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner