Provider Demographics
NPI:1285831073
Name:CONWAY, KATHLEEN FURTH (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FURTH
Last Name:CONWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MERRITT BLVD
Mailing Address - Street 2:ST. VINCENT'S SPECIAL NEEDS SERVICES
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5435
Mailing Address - Country:US
Mailing Address - Phone:203-386-2744
Mailing Address - Fax:203-386-2738
Practice Address - Street 1:95 MERRITT BLVD
Practice Address - Street 2:ST. VINCENT'S SPECIAL NEEDS SERVICES
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5435
Practice Address - Country:US
Practice Address - Phone:203-386-2744
Practice Address - Fax:203-386-2738
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001894363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics