Healthcare Provider Details

I. General information

NPI: 1699773374
Provider Name (Legal Business Name): DIANNE M CONRAD FNP, RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 PROFESSIONAL DR
CADILLAC MI
49601-8599
US

IV. Provider business mailing address

8950 PROFESSIONAL DR
CADILLAC MI
49601-8599
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-2493
  • Fax: 231-779-7701
Mailing address:
  • Phone: 231-775-2493
  • Fax: 231-775-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberDC143654
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: