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NPI Code Detail

MEDICARE: MARY EDITH CONWAY MS, CGC

MEDICARE:   MARY EDITH CONWAY  MS, CGC
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1538439344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY EDITH CONWAY MS, CGC
Provider Business Mailing Address
First Line : 900 N LIBERTY ST STE 206
Second Line :
City : BOISE
State : ID
Zip : 83704-8729
Country : US
Telephone Number : 208-367-5597
Fax Number :
Provider Business Practice Location Address
First Line : 900 N LIBERTY ST STE 206
Second Line :
City : BOISE
State : ID
Zip : 83704-8729
Country : US
Telephone Number : 208-367-5597
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 01/10/2012

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Directions to “ MARY EDITH CONWAY MS, CGC” Practice Location

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