Provider Demographics
NPI:1811023047
Name:CONWAY, CASEY (RCS)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26410 RAMPART BLVD APT 723
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6607
Mailing Address - Country:US
Mailing Address - Phone:941-916-5371
Mailing Address - Fax:
Practice Address - Street 1:4161 TAMIAMI TRL # 701
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-916-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00053524246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography