Healthcare Provider Details

I. General information

NPI: 1689643231
Provider Name (Legal Business Name): ELIZABETH CONWAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORNAC JOHN CUMING BLDG #200
CONCORD MA
01742
US

IV. Provider business mailing address

149 13TH ST
CHARLESTOWN MA
02129-2020
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3436
  • Fax: 978-287-3642
Mailing address:
  • Phone: 617-726-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23838
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: