Healthcare Provider Details

I. General information

NPI: 1063635498
Provider Name (Legal Business Name): TONI RENAY CONRADS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 16TH CT NE
ISSAQUAH WA
98029
US

IV. Provider business mailing address

1989 16TH CT NE
ISSAQUAH WA
98029
US

V. Phone/Fax

Practice location:
  • Phone: 206-619-9858
  • Fax:
Mailing address:
  • Phone: 206-619-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: