Provider Demographics
NPI:1891470688
Name:CONRAD, MELANIE (RN/IBCLC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RN/IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S IDAHO RD LOT 907
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-5249
Mailing Address - Country:US
Mailing Address - Phone:561-436-5891
Mailing Address - Fax:
Practice Address - Street 1:8400 S KYRENE RD STE 126
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2172
Practice Address - Country:US
Practice Address - Phone:480-442-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ281079163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant