Provider Demographics
NPI:1619591070
Name:CONRAD, ALEXANDRA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1919
Mailing Address - Country:US
Mailing Address - Phone:913-558-1345
Mailing Address - Fax:
Practice Address - Street 1:48 GASPEE POINT DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-4918
Practice Address - Country:US
Practice Address - Phone:913-558-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant