MEDICARE: JENNIFER L CONWAY STORY PA

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
1	363AM0700X	Medical Physician Assistant	920	CO
2	363AM0700X	Medical Physician Assistant	0662	NH

General Provider Information

NPI Number	:	1174543037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L CONWAY STORY PA

Provider Business Mailing Address
First Line	:	990 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-602-8976
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-602-8976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/07/2021

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Directions to “ JENNIFER L CONWAY STORY PA” Practice Location

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