Healthcare Provider Details

I. General information

NPI: 1255027041
Provider Name (Legal Business Name): VINICIA ANNE CONWAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

1101 N MOUNTAIN VIEW AVE APT M61
TACOMA WA
98406-8402
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2715
  • Fax:
Mailing address:
  • Phone: 720-320-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP6143695
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0998516-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0998516-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0998516-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0998516-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: