Provider Demographics
NPI:1285745935
Name:CONWAY, LILLIAN M (RN,MS,FNP-CS)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RN,MS,FNP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ARGUS LN STE G
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6973
Mailing Address - Country:US
Mailing Address - Phone:704-660-4362
Mailing Address - Fax:704-663-0442
Practice Address - Street 1:128 ARGUS LN STE G
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6973
Practice Address - Country:US
Practice Address - Phone:704-660-4362
Practice Address - Fax:704-663-0442
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184701Medicaid
NY000497747001OtherBSNENY
NY070327000103OtherFIDELIS
NY356359OtherMVP HEALTHCARE
NY200312OtherSENIOR WHOLE HEALTH
NY77645OtherGHI/HMO
NYBB5661Medicare ID - Type Unspecified
NY02184701Medicaid