Provider Demographics
NPI:1912494311
Name:CONWAY, GRACE JACOBSON (CNP (CERTIFIED NURSE)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:JACOBSON
Last Name:CONWAY
Suffix:
Gender:F
Credentials:CNP (CERTIFIED NURSE
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:HANNAH ISABELLA
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP (CERTIFIED NURSE
Mailing Address - Street 1:201 CEDAR ST SE S1-20
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4900
Mailing Address - Country:US
Mailing Address - Phone:505-248-0000
Mailing Address - Fax:505-842-0000
Practice Address - Street 1:201 CEDAR ST SE S1-20
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4900
Practice Address - Country:US
Practice Address - Phone:505-248-0000
Practice Address - Fax:505-842-0000
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03505363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health