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General NPI Number Information
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NPI Number | 1306857511
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Entity Type | Individual
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Provider Name | CAROLYN M CONAWAY P.A.C.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1051 W US ROUTE 6 SUITE 100
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City | MORRIS
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State | IL
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Zip | 60450-3349
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Country | US
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Telephone | 815-942-4875
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Fax | 815-942-5046
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Provider Business Mailing Address
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Address Line | 1051 W US ROUTE 6 SUITE 100
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City | MORRIS
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State | IL
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Zip | 60450-3349
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Country | US
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Telephone | 815-942-4875
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Fax | 815-942-5046
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04919
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License Number State | TX
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