Provider Demographics
NPI:1740901461
Name:CONWAY, NATHAN MICHAEL (MS, BA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:CONWAY
Suffix:
Gender:M
Credentials:MS, BA
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:MICHAEL
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BA
Mailing Address - Street 1:6626 CHAPEL HILL BLVD APT E302
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5337
Mailing Address - Country:US
Mailing Address - Phone:253-561-4346
Mailing Address - Fax:
Practice Address - Street 1:3021 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2740
Practice Address - Country:US
Practice Address - Phone:509-420-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer