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NPI Code Detail

MEDICARE: STACY LYNN CONWAY RN

MEDICARE: STACY LYNN CONWAY RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse221268NC

General Provider Information

NPI Number : 1073476263
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY LYNN CONWAY RN
Provider Business Mailing Address
First Line : 600 GREENVILLE BLVD SE STE H
Second Line : #1039
City : GREENVILLE
State : NC
Zip : 27858-6700
Country : US
Telephone Number : 252-320-2488
Fax Number :
Provider Business Practice Location Address
First Line : 2100 STANTONSBURG RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2818
Country : US
Telephone Number : 252-847-5791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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