Provider Demographics
NPI:1972959021
Name:CONWAY, NANCY (282424-1)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:282424-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 THOUSAND ACRES RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-1917
Mailing Address - Country:US
Mailing Address - Phone:518-875-6724
Mailing Address - Fax:518-875-6389
Practice Address - Street 1:395 N GRAND ST
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4168
Practice Address - Country:US
Practice Address - Phone:518-234-8864
Practice Address - Fax:518-234-8847
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282424-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse