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General NPI Number Information
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NPI Number | 1033822960
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Entity Type | Organization
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Legal Business Name | CONWAY MEDICAL AND WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 805 MONROE ST STE 104
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City | CONWAY
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State | AR
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Zip | 72032-5642
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Country | US
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Telephone | 501-932-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 118 EAGLE RIDGE DR
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City | MAUMELLE
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State | AR
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Zip | 72113-7649
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Country | US
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Telephone | 501-733-6124
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Fax |
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Authorized Official
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Title or Position | OWNER/APRN
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Name | SHARONTE LAMBERT FOWLER
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Credential | APRN
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Telephone | 501-733-6124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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