Provider Demographics
NPI:1073985339
Name:CONRAD, WHITNEY BLANCHARD (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:BLANCHARD
Last Name:CONRAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1226 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7049
Mailing Address - Country:US
Mailing Address - Phone:208-331-1155
Mailing Address - Fax:
Practice Address - Street 1:1226 W RIVER ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7049
Practice Address - Country:US
Practice Address - Phone:208-331-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57349363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIU033Z-TPAMedicare PIN