Provider Demographics
NPI:1912917303
Name:CONWAY, ALICE E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:E
Last Name:CONWAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4741
Mailing Address - Country:US
Mailing Address - Phone:814-459-6777
Mailing Address - Fax:814-459-6367
Practice Address - Street 1:2059 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4741
Practice Address - Country:US
Practice Address - Phone:814-459-6777
Practice Address - Fax:814-459-6367
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005667B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP70396Medicare UPIN
PA063499Medicare ID - Type UnspecifiedMEDICARE