Provider Demographics
NPI:1740418417
Name:CONRAD, TERRY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1032
Mailing Address - Country:US
Mailing Address - Phone:914-708-7222
Mailing Address - Fax:
Practice Address - Street 1:7 RIVER RD UNIT 307
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2719
Practice Address - Country:US
Practice Address - Phone:914-708-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303950363LA2200X
CT001982363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health