Healthcare Provider Details

I. General information

NPI: 1447672159
Provider Name (Legal Business Name): JAIME RENEE KONRAD C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 REMSEN ST APT 9A
BROOKLYN NY
11201-3432
US

IV. Provider business mailing address

195 HICKS ST APT 5C
BROOKLYN NY
11201-4185
US

V. Phone/Fax

Practice location:
  • Phone: 314-276-7381
  • Fax:
Mailing address:
  • Phone: 314-276-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number570180-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR15322600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: