Healthcare Provider Details

I. General information

NPI: 1427474972
Provider Name (Legal Business Name): JENNIFER ANN CONRAD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41755 HELLER SPRINGS RD
ANZA CA
92539-8846
US

IV. Provider business mailing address

72047 DINAH SHORE DR SUITE #C-4
RANCHO MIRAGE CA
92270-1790
US

V. Phone/Fax

Practice location:
  • Phone: 951-323-3337
  • Fax:
Mailing address:
  • Phone: 760-770-7600
  • Fax: 760-770-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: