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Individual

MS. LISA MARIE CONWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2716 OLD ROSEBUD RD, LEXINGTON, KY 40509-8008
(859) 543-1577
Mailing address
2716 OLD ROSEBUD RD, LEXINGTON, KY 40509-8008
(859) 543-1577

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.002674
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
50.002674
OH LICENSE
OH
05
7100036940
KY
01
PA1092
LICENSE
KY
Enumeration date
12/04/2007
Last updated
12/02/2020
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