MEDICARE: ELISABETH H CONRAD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024166028	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06115	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1336230515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH H CONRAD NP

Provider Business Mailing Address
First Line	:	9113 DICKEY DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2502
Country	:	US
Telephone Number	:	804-559-7280
Fax Number	:	804-559-7282

Provider Business Practice Location Address
First Line	:	9113 DICKEY DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2502
Country	:	US
Telephone Number	:	804-559-7280
Fax Number	:	804-559-7282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/21/2016

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Directions to “ ELISABETH H CONRAD NP” Practice Location

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