Provider Demographics
NPI:1871903088
Name:CONWAY, EMILY (RN, LMT, NTS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RN, LMT, NTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 LA LUZ DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3548
Mailing Address - Country:US
Mailing Address - Phone:505-600-2497
Mailing Address - Fax:
Practice Address - Street 1:1127 LA LUZ DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3548
Practice Address - Country:US
Practice Address - Phone:505-600-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68430163WC0200X
NMMT7009225700000X
NM68430-MT7009163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMT7009OtherNM MASSAGE THERAPY BOARD
NM68430OtherNEW MEXICO BOARD OF NURSING