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General NPI Number Information
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NPI Number | 1053221622
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Entity Type | Individual
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Provider Name | ANTHONY J CONWAY
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Gender | Male
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1913 W TOWNLINE RD
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City | PEORIA
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State | IL
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Zip | 61615-1621
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Country | US
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Telephone | 309-271-7182
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Fax | 309-689-3613
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Provider Business Mailing Address
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Address Line | 910 WASHINGTON ST
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City | PEKIN
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State | IL
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Zip | 61554-4831
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Country | US
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Telephone | 309-271-7182
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Fax | 309-689-3613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.415598
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License Number State | IL
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