Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 13-53066-031 | KS |
NPI | 1043347453 |
---|---|
Provider Name | Mrs. Carolyn J Conaway |
First Address | Topeka, KS 66604-4333 |
Second Address | Topeka, KS 66604-4333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100255410B | (05) | KS |