Provider Demographics
NPI:1710208434
Name:CONLEY, AMIE LEE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AMIE
Middle Name:LEE
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 1:517 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WISCONSIN
Mailing Address - Zip Code:53147
Mailing Address - Country:UM
Mailing Address - Phone:262-676-1422
Mailing Address - Fax:
Practice Address - Street 1:517 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1321
Practice Address - Country:US
Practice Address - Phone:262-676-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306818031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse