Provider Demographics
NPI:1841674892
Name:CONWAY, EVETTE (LPN)
Entity type:Individual
Prefix:
First Name:EVETTE
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4296 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6353
Mailing Address - Country:US
Mailing Address - Phone:216-254-3884
Mailing Address - Fax:
Practice Address - Street 1:1630 PARKER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-3619
Practice Address - Country:US
Practice Address - Phone:216-254-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 385HR2065X, 372500000X
OHPN.158460-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No164W00000XNursing Service ProvidersLicensed Practical Nurse