Healthcare Provider Details

I. General information

NPI: 1871903088
Provider Name (Legal Business Name): EMILY CONWAY RN, LMT, NTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 LA LUZ DR NW
ALBUQUERQUE NM
87107-3548
US

IV. Provider business mailing address

1127 LA LUZ DR NW
ALBUQUERQUE NM
87107-3548
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-2497
  • Fax:
Mailing address:
  • Phone: 505-600-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number68430
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT7009
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number68430-MT7009
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: