Provider Demographics
NPI:1760852149
Name:CHANCE, CONROY BURN
Entity Type:Individual
Prefix:
First Name:CONROY
Middle Name:BURN
Last Name:CHANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1682
Mailing Address - Country:US
Mailing Address - Phone:513-376-0005
Mailing Address - Fax:513-834-9323
Practice Address - Street 1:4747 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1682
Practice Address - Country:US
Practice Address - Phone:513-376-0005
Practice Address - Fax:513-834-9323
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163WHO200X163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health