Healthcare Provider Details

I. General information

NPI: 1881828655
Provider Name (Legal Business Name): RACHEL CONRAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL SULLIVAN

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

3000 S DENVER WAY
BOISE ID
83705-5287
US

V. Phone/Fax

Practice location:
  • Phone: 208-205-7273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number5671438
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number5671438
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: