Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN022461 | GA |
NPI | 1508934563 |
---|---|
Provider Name | Mrs. Marian A Conway |
First Address | Hawkinsville, GA 31036-8926 |
Second Address | Unadilla, GA 31091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |