MEDICARE: EVETTE 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
1	376J00000X	Homemaker		OH
2	385HR2065X	Child Physical Disabilities Respite Care		OH
3	164W00000X	Licensed Practical Nurse	PN.158460-M-IV	OH
4	372500000X	Chore Provider		OH

General Provider Information

NPI Number	:	1841674892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVETTE CONWAY LPN

Provider Business Mailing Address
First Line	:	4296 E 131ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6353
Country	:	US
Telephone Number	:	216-254-3884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 PARKER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-3619
Country	:	US
Telephone Number	:	216-254-3884
Fax Number	:

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

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	12/18/2024

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