Provider Demographics
NPI:1629850292
Name:CONWAY, CAROLANN ITHICA
Entity Type:Individual
Prefix:
First Name:CAROLANN
Middle Name:ITHICA
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 N 21ST ST # 202
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2956
Mailing Address - Country:US
Mailing Address - Phone:740-817-0513
Mailing Address - Fax:
Practice Address - Street 1:116 N 22ND ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2755
Practice Address - Country:US
Practice Address - Phone:740-817-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion