Basic Information
Provider Information | |||||||||
NPI: | 1174908206 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CONLEY | ||||||||
FirstName: | JANET | ||||||||
MiddleName: | ELAINE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GULLETT | ||||||||
OtherFirstName: | JANET | ||||||||
OtherMiddleName: | ELAINE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | REFFETT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1730 | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922701058 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6056826847 | ||||||||
FaxNumber: | 7608372202 | ||||||||
Practice Location | |||||||||
Address1: | 39700 BOB HOPE DR STE 310 | ||||||||
Address2: |   | ||||||||
City: | RANCHO MIRAGE | ||||||||
State: | CA | ||||||||
PostalCode: | 922703267 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7605682684 | ||||||||
FaxNumber: | 7603415832 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/30/2015 | ||||||||
LastUpdateDate: | 06/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0000X | 95159747 | CA | Y |   | Nursing Service Providers | Registered Nurse | Pain Management |
No ID Information.