Provider Demographics
NPI:1982140885
Name:CONQUER, PLLC
Entity Type:Organization
Organization Name:CONQUER, PLLC
Other - Org Name:CONQUER HEALTHCARE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LOKESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCHIREDDIGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:480-652-2931
Mailing Address - Street 1:10820 N 127TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4330
Mailing Address - Country:US
Mailing Address - Phone:480-652-2931
Mailing Address - Fax:
Practice Address - Street 1:9375 E SHEA BLVD STE 266
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-652-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5312261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538575253OtherNPPES-INDIVIDUAL NPI
AZ977793Medicaid
AZ977793Medicaid