Provider Demographics
NPI:1912413907
Name:CONWAY, ELLERY ANN
Entity Type:Individual
Prefix:
First Name:ELLERY
Middle Name:ANN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DODGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2114
Mailing Address - Country:US
Mailing Address - Phone:401-862-3561
Mailing Address - Fax:
Practice Address - Street 1:8 DODGE CT
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2114
Practice Address - Country:US
Practice Address - Phone:401-862-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion