Provider Demographics
NPI:1063066504
Name:CONWAY-O'NEILL, MORGAN BRIGID (LM, CPM)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BRIGID
Last Name:CONWAY-O'NEILL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514A PETERSEN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1730
Mailing Address - Country:US
Mailing Address - Phone:707-695-1831
Mailing Address - Fax:
Practice Address - Street 1:514A PETERSEN LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-1730
Practice Address - Country:US
Practice Address - Phone:707-695-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife