Provider Demographics
NPI:1316535826
Name:CONWAY, ALISSA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:KELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1364 HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4443
Mailing Address - Country:US
Mailing Address - Phone:330-272-1646
Mailing Address - Fax:
Practice Address - Street 1:1364 HILLSDALE DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4443
Practice Address - Country:US
Practice Address - Phone:330-272-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMAO62217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant