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NPI Code Detail

MEDICARE: CICELY ROSE CONWAY PA-C

MEDICARE: CICELY ROSE CONWAY PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1689328742
Entity Type Code : Individual
Provider Name (Legal Business Name) : CICELY ROSE CONWAY PA-C
Provider Business Mailing Address
First Line : 303 W 35TH ST APT 302
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1441
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4900 MUELLER BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78723-3051
Country : US
Telephone Number : 512-324-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2022
Last Update Date : 02/08/2022

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Directions to “ CICELY ROSE CONWAY PA-C” Practice Location

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