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NPI Code Detail

MEDICARE: DIANE MARIE CONWAY MSN, FNP

MEDICARE: DIANE MARIE CONWAY MSN, FNP
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
1363LF0000XFamily Nurse Practitioner2543-033WI

General Provider Information

NPI Number : 1104820448
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE MARIE CONWAY MSN, FNP
Provider Business Mailing Address
First Line : 4226 BAYBROOK DR
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-3547
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 OVERLOOK TER
Second Line :
City : MADISON
State : WI
Zip : 53705-2254
Country : US
Telephone Number : 608-256-1901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/10/2007

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