Provider Demographics
NPI:1790705929
Name:CONNER, SHELLEY L (RN, CDE)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:CONNER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 SW CARY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6224
Mailing Address - Country:US
Mailing Address - Phone:919-387-3200
Mailing Address - Fax:919-387-3201
Practice Address - Street 1:1515 SW CARY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3200
Practice Address - Fax:919-387-3201
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL150403133NN1002X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2994576Medicare PIN