MEDICARE: KIRSTEN MARIE CONRAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN432450	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0032247	OH

General Provider Information

NPI Number	:	1952868077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN MARIE CONRAD

Provider Business Mailing Address
First Line	:	1874 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2263
Country	:	US
Telephone Number	:	330-262-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1874 CLEVELAND RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2263
Country	:	US
Telephone Number	:	330-262-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	09/26/2022

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