Healthcare Provider Details

I. General information

NPI: 1639403959
Provider Name (Legal Business Name): DAVID A CONRAD CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 07/20/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 G AVE
NEW CUMBERLAND PA
17070
US

IV. Provider business mailing address

400 G AVE
NEW CUMBERLAND PA
17070
US

V. Phone/Fax

Practice location:
  • Phone: 717-770-7281
  • Fax: 717-770-8484
Mailing address:
  • Phone: 717-770-7281
  • Fax: 717-770-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010416
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: