Healthcare Provider Details

I. General information

NPI: 1730180928
Provider Name (Legal Business Name): SHARYN N CONRAD DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 WESTGATE CENTER DR
WINSTON SALEM NC
27103-2934
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-0100
  • Fax: 336-718-0120
Mailing address:
  • Phone: 336-718-0100
  • Fax: 336-718-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200933
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: