MEDICARE: MISS COURTNEY G CONRAD LPN

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	164W00000X	Licensed Practical Nurse	281825	NY

General Provider Information

NPI Number	:	1538347877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COURTNEY G CONRAD LPN

Provider Business Mailing Address
First Line	:	217 TAURUS RD
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-2430
Country	:	US
Telephone Number	:	518-641-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 TAURUS RD
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12304-2430
Country	:	US
Telephone Number	:	518-641-2193
Fax Number	:

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

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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