Provider Demographics
NPI:1093936163
Name:CONRAD, VICTORIA L (MSN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:L
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:L
Other - Last Name:FRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:51 N. 39TH ST
Mailing Address - Street 2:WS - 266 DEPT OF SURGERY
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-9708
Mailing Address - Fax:215-243-3250
Practice Address - Street 1:51 N. 39TH ST WS - 266 DEPT OF SURGERY
Practice Address - Street 2:PENN - PRESBYTERIAN MEDICAL CENTER
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9708
Practice Address - Fax:215-243-3250
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily