Provider Demographics
NPI:1316371685
Name:CONRAD, KYRRAS AYRYK (RN)
Entity Type:Individual
Prefix:
First Name:KYRRAS
Middle Name:AYRYK
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:D-408
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-971-4444
Mailing Address - Fax:
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:D-408
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-971-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113340163W00000X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163W00000XNursing Service ProvidersRegistered Nurse