Provider Demographics
NPI:1891000766
Name:CONWAY, MARY MAPELLI (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MAPELLI
Last Name:CONWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:MAPELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 BEGIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2817
Mailing Address - Country:US
Mailing Address - Phone:510-636-1228
Mailing Address - Fax:
Practice Address - Street 1:405 BEGIER AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2817
Practice Address - Country:US
Practice Address - Phone:510-636-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily