Provider Demographics
NPI:1275950230
Name:CONWAY, ELISA (APN)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 NEW ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3534
Mailing Address - Country:US
Mailing Address - Phone:609-926-8899
Mailing Address - Fax:856-772-1997
Practice Address - Street 1:2106 NEW RD STE D4
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1050
Practice Address - Country:US
Practice Address - Phone:609-926-6474
Practice Address - Fax:609-926-6474
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00505100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily