Provider Demographics
NPI:1609814557
Name:CONLEY, ROBERT M (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CONLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23035 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CA
Mailing Address - Zip Code:95669-9529
Mailing Address - Country:US
Mailing Address - Phone:901-268-4952
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-7705
Practice Address - Fax:916-973-6354
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100026367500000X
CA434182367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3130716OtherBLUE CROSS
430050588OtherRAILROAD MEDICARE
TN3622612Medicaid
MS08359247Medicaid
TN3622614Medicare PIN