Provider Demographics
NPI:1790251577
Name:CONWAY, ERICA MONIQUE (APRN)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MONIQUE
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 1:1511 N SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-9650
Mailing Address - Country:US
Mailing Address - Phone:870-826-2168
Mailing Address - Fax:
Practice Address - Street 1:1511 N SHERMAN ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-9650
Practice Address - Country:US
Practice Address - Phone:870-826-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily