Provider Demographics
NPI:1639199516
Name:CONRAD, SHERRIE J (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:J
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:SHERRIE
Other - Middle Name:J
Other - Last Name:EAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRCHILD CT
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5164
Practice Address - Country:US
Practice Address - Phone:530-668-2600
Practice Address - Fax:530-669-3661
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00745218OtherMEDICARE RAILROAD CARRIER
CAPA17010OtherMEDI-CAL
CD314ZMedicare PIN