MEDICARE: EMILY CONWAY RN, LMT, NTS

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	163WC0200X	Critical Care Medicine Registered Nurse	68430	NM
2	225700000X	Massage Therapist	MT7009	NM
3	163WM1400X	Nurse Massage Therapist (NMT)	68430-MT7009	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT7009	OTHER	NM	NM MASSAGE THERAPY BOARD
2	68430	OTHER	NM	NEW MEXICO BOARD OF NURSING

General Provider Information

NPI Number	:	1871903088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CONWAY RN, LMT, NTS

Provider Business Mailing Address
First Line	:	1127 LA LUZ DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3548
Country	:	US
Telephone Number	:	505-600-2497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 LA LUZ DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3548
Country	:	US
Telephone Number	:	505-600-2497
Fax Number	:

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

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	12/20/2023

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