1841955036 NPI number — JENNIFER RAE HUNLEY-CONWAY CPM

Table of content: JENNIFER RAE HUNLEY-CONWAY CPM (NPI 1841955036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841955036 NPI number — JENNIFER RAE HUNLEY-CONWAY CPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNLEY-CONWAY
Provider First Name:
JENNIFER
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONWAY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841955036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 TINDAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29617-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-631-7449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301B TINDAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29617-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-631-7449
Provider Business Practice Location Address Fax Number:
864-641-1320
Provider Enumeration Date:
11/03/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X , with the licence number: LMW-0114 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)