Provider Demographics
NPI:1710220652
Name:CONRAD, MARIBETH (APRN-GNP)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:APRN-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3353
Mailing Address - Country:US
Mailing Address - Phone:308-763-1354
Mailing Address - Fax:
Practice Address - Street 1:503 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3831
Practice Address - Country:US
Practice Address - Phone:308-763-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111470363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology