Provider Demographics
NPI:1669998472
Name:CONLAN, JODI MARIE (NP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:CONLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 DUANESBURG RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DUANESBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12056-3422
Mailing Address - Country:US
Mailing Address - Phone:518-299-5007
Mailing Address - Fax:
Practice Address - Street 1:4780 DUANESBURG RD STE 102
Practice Address - Street 2:
Practice Address - City:DUANESBURG
Practice Address - State:NY
Practice Address - Zip Code:12056-3422
Practice Address - Country:US
Practice Address - Phone:518-299-5007
Practice Address - Fax:518-510-9783
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY340971363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04850120Medicaid