Provider Demographics
NPI:1679211452
Name:CONWELL, KATHRYN LAURA (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LAURA
Last Name:CONWELL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BETTY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-4220
Mailing Address - Country:US
Mailing Address - Phone:603-819-1846
Mailing Address - Fax:
Practice Address - Street 1:175 BETTY SPRING RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-4220
Practice Address - Country:US
Practice Address - Phone:603-819-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2361388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse