Provider Demographics
NPI:1467880161
Name:CONRAD, BETHANY JOY (RN, CNM)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JOY
Other - Last Name:HEPPNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2761 FALLON CIR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4722
Mailing Address - Country:US
Mailing Address - Phone:805-791-5332
Mailing Address - Fax:
Practice Address - Street 1:2761 FALLON CIR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4722
Practice Address - Country:US
Practice Address - Phone:805-791-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2078367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife