Provider Demographics
NPI:1902400039
Name:CONLEE, CAROL A
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:CONLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:ANAMOOSE
Mailing Address - State:ND
Mailing Address - Zip Code:58710-0147
Mailing Address - Country:US
Mailing Address - Phone:170-123-0161
Mailing Address - Fax:
Practice Address - Street 1:4 AVE H WEST
Practice Address - Street 2:
Practice Address - City:ANAMOOSE
Practice Address - State:ND
Practice Address - Zip Code:58710-0147
Practice Address - Country:US
Practice Address - Phone:701-230-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant