Provider Demographics
NPI:1386181816
Name:CONWAY, DANIEL P (FNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:P
Last Name:CONWAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:745 WANG
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-5687
Mailing Address - Fax:617-643-7836
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:745 WANG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-5687
Practice Address - Fax:617-643-7836
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2259039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner