Provider Demographics
NPI:1487904074
Name:CONLEY, POLLY KAY (RN, PNP)
Entity type:Individual
Prefix:MS
First Name:POLLY
Middle Name:KAY
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10644 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-3408
Mailing Address - Country:US
Mailing Address - Phone:530-613-3116
Mailing Address - Fax:
Practice Address - Street 1:844 OLD TUNNEL RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-274-9762
Practice Address - Fax:530-273-0698
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14104363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics