Provider Demographics
NPI:1992092795
Name:CONWAY, HEATHER EVE (LAC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:EVE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 E JEWELL AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4508
Mailing Address - Country:US
Mailing Address - Phone:720-244-6222
Mailing Address - Fax:
Practice Address - Street 1:4155 E JEWELL AVE STE 414
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4508
Practice Address - Country:US
Practice Address - Phone:720-244-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1540171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist