Healthcare Provider Details

I. General information

NPI: 1609124866
Provider Name (Legal Business Name): CAMILLE E. CONWAY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W BELTLINE HWY
MADISON WI
53713-2316
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-2100
  • Fax: 608-417-2101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4954-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: