| NPI | 1952066342 |
|---|---|
| Former Name | CHANNEN MARIE CONWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5015352) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC DANK-KW1CG) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-12-11 |