Provider Demographics
NPI:1649536699
Name:CONWAY, KIM (CNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8488
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8488
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13238-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health