Provider Demographics
NPI:1447039433
Name:CONLEY, OMA DOCETTA
Entity type:Individual
Prefix:
First Name:OMA DOCETTA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5795
Mailing Address - Country:US
Mailing Address - Phone:219-487-9481
Mailing Address - Fax:219-203-4077
Practice Address - Street 1:7631 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5795
Practice Address - Country:US
Practice Address - Phone:219-487-9481
Practice Address - Fax:219-203-4077
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide