Provider Demographics
NPI:1861456758
Name:CONLEY, CHARLENE L (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:L
Last Name:CONLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 SNYDER DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9497
Mailing Address - Country:US
Mailing Address - Phone:716-433-8751
Mailing Address - Fax:716-433-8792
Practice Address - Street 1:5879 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-433-8751
Practice Address - Fax:716-433-8792
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3310851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9511785OtherINDEPENDENT HEALTH
NY040426002607OtherFIDELIS
NY000560122004OtherBCBS OF WNY
NY00026578701OtherUNIVERA
NYS59965Medicare UPIN
NYDD3106Medicare ID - Type Unspecified