Healthcare Provider Details

I. General information

NPI: 1841674892
Provider Name (Legal Business Name): EVETTE CONWAY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 PARKER DR
CLEVELAND OH
44124-3619
US

IV. Provider business mailing address

4296 E 131ST ST
CLEVELAND OH
44105-6353
US

V. Phone/Fax

Practice location:
  • Phone: 216-254-3884
  • Fax:
Mailing address:
  • Phone: 216-254-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.158460-M-IV
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: