Provider Demographics
NPI:1407858509
Name:CONRAD, MARY (WHNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 SHANK RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6823
Mailing Address - Country:US
Mailing Address - Phone:302-739-4728
Mailing Address - Fax:302-739-7735
Practice Address - Street 1:805 RIVER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3753
Practice Address - Country:US
Practice Address - Phone:302-739-4728
Practice Address - Fax:302-739-7735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH0000134363LW0102X
PAUP004281G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology