MEDICARE: MRS. ASHLEY MARIE CONWAY PA-C

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
1	363AM0700X	Medical Physician Assistant	5468	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5468	OTHER	AZ	ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS

General Provider Information

NPI Number	:	1396179685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MARIE CONWAY PA-C

Provider Business Mailing Address
First Line	:	1688 E. BOSTON ST.
Second Line	:	SUITE#101
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	480-855-0085
Fax Number	:	480-855-0086

Provider Business Practice Location Address
First Line	:	1688 E. BOSTON ST.
Second Line	:	SUITE#101
City	:	GILBERT
State	:	AZ
Zip	:	85295-6220
Country	:	US
Telephone Number	:	480-855-0085
Fax Number	:	480-855-0086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	07/21/2022

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