Provider Demographics
NPI:1639683121
Name:CONRAD, DANA (373H00000X)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:373H00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N BUERKLE ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-2519
Mailing Address - Country:US
Mailing Address - Phone:870-659-6221
Mailing Address - Fax:
Practice Address - Street 1:1801 N BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-2519
Practice Address - Country:US
Practice Address - Phone:870-659-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR373H00000XOtherEASTERSEALS