Provider Demographics
NPI:1699425066
Name:CONWAY, MONICA (APRN)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 KEEPATAW DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4342
Mailing Address - Country:US
Mailing Address - Phone:630-240-4572
Mailing Address - Fax:
Practice Address - Street 1:1192 WALTER ST STE C
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2905
Practice Address - Country:US
Practice Address - Phone:630-310-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner