Provider Demographics
NPI:1669753828
Name:CONWAY, JAIME M (MPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SW C AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4400
Mailing Address - Country:US
Mailing Address - Phone:541-207-3900
Mailing Address - Fax:541-207-3232
Practice Address - Street 1:305 SW C AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4400
Practice Address - Country:US
Practice Address - Phone:541-207-3900
Practice Address - Fax:541-207-3232
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA165150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical