Provider Demographics
NPI:1992010532
Name:CONAWAY, DORIS L (LICENSE PRACTICAL NU)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:L
Last Name:CONAWAY
Suffix:
Gender:F
Credentials:LICENSE PRACTICAL NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961
Mailing Address - Country:US
Mailing Address - Phone:631-744-8831
Mailing Address - Fax:631-744-8831
Practice Address - Street 1:159 RIDGE RD
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961
Practice Address - Country:US
Practice Address - Phone:631-744-8831
Practice Address - Fax:631-744-8831
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143868-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse