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General NPI Number Information
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NPI Number | 1730648502
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Entity Type | Individual
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Provider Name | MS. CATIE ARDEAN CONRAD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 440 E STATE ST STE 100
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-939-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 3326 N WHISTLER LN APT 102
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City | BOISE
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State | ID
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Zip | 83703-6234
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Country | US
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Telephone | 775-287-0488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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