Provider Demographics
NPI:1861955932
Name:CONWAY, APRIL NICOLE (AGNP)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:NICOLE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5352
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0352
Mailing Address - Country:US
Mailing Address - Phone:989-860-0088
Mailing Address - Fax:989-791-3859
Practice Address - Street 1:1525 W CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9686
Practice Address - Country:US
Practice Address - Phone:989-860-0088
Practice Address - Fax:989-791-3859
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG04190012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAG04190012Medicaid
MIAG04190012OtherCOMMERCIAL