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NPI Code Detail

MEDICARE: DORIS GAIL CONWAY LPN

MEDICARE:   DORIS GAIL CONWAY  LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse180773AK

General Provider Information

NPI Number : 1194490318
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIS GAIL CONWAY LPN
Provider Business Mailing Address
First Line : 8290 GOURDNECK VALLEY RD
Second Line :
City : MALVERN
State : AR
Zip : 72104-7133
Country : US
Telephone Number : 501-743-8939
Fax Number :
Provider Business Practice Location Address
First Line : 8290 GOURDNECK VALLEY RD
Second Line :
City : MALVERN
State : AR
Zip : 72104-7133
Country : US
Telephone Number : 501-743-8939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2021
Last Update Date : 08/10/2021

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Directions to “ DORIS GAIL CONWAY LPN” Practice Location

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