Healthcare Provider Details

I. General information

NPI: 1053221622
Provider Name (Legal Business Name): ANTHONY J CONWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 W TOWNLINE RD
PEORIA IL
61615-1621
US

IV. Provider business mailing address

910 WASHINGTON ST
PEKIN IL
61554-4831
US

V. Phone/Fax

Practice location:
  • Phone: 309-271-7182
  • Fax: 309-689-3613
Mailing address:
  • Phone: 309-271-7182
  • Fax: 309-689-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.415598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: