Healthcare Provider Details

I. General information

NPI: 1518976802
Provider Name (Legal Business Name): SUZANNE S CONRAD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNA SHUNK CONRAD ARNP

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 LANCASTER DRIVE SE
SALEM OR
97317
US

IV. Provider business mailing address

16966 SUMMER PL
LAKE OSWEGO OR
97035-4595
US

V. Phone/Fax

Practice location:
  • Phone: 352-494-9967
  • Fax: 402-858-4043
Mailing address:
  • Phone: 352-494-9967
  • Fax: 402-858-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3386612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: