Provider Demographics
NPI:1346217684
Name:CONLEY, GRETCHEN V (ANP)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:V
Last Name:CONLEY
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:V
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9325
Mailing Address - Country:US
Mailing Address - Phone:317-885-9109
Mailing Address - Fax:
Practice Address - Street 1:2275 WILLOW LAKE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9325
Practice Address - Country:US
Practice Address - Phone:317-885-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28094532A163W00000X
IN71001092A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN13244XMedicare ID - Type Unspecified
INP39596Medicare UPIN