Provider Demographics
NPI:1104343037
Name:CONLEY, DOROTHY MAE (RN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MAE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7250
Mailing Address - Country:US
Mailing Address - Phone:409-771-2484
Mailing Address - Fax:346-240-4623
Practice Address - Street 1:5305 WILMINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3256
Practice Address - Country:US
Practice Address - Phone:346-240-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235051163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator