Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN.CNP.024503 | OH |
NPI | 1023670718 |
---|---|
Provider Name | Alycia Conway |
First Address | Cleveland, OH 44106-2319 |
Second Address | Cleveland, OH 44106-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |