Healthcare Provider Details

I. General information

NPI: 1366982589
Provider Name (Legal Business Name): THERESA CONWAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 ROUTE 70 W STE 3003
CHERRY HILL NJ
08002-3315
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3597
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax: 215-707-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP016964
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00718100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: