Provider Demographics
NPI:1750942587
Name:CONRAD, MARY ALANNA (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALANNA
Last Name:CONRAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ALANNA
Other - Middle Name:
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:201 BRADBURY LANE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061
Mailing Address - Country:US
Mailing Address - Phone:650-380-5007
Mailing Address - Fax:
Practice Address - Street 1:500 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4345
Practice Address - Country:US
Practice Address - Phone:408-554-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN422215363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool