Provider Demographics
NPI:1780921445
Name:CONRAD, SHELLEY (MIDWIFE)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 62 BOX 36
Mailing Address - Street 2:
Mailing Address - City:ZENIA
Mailing Address - State:CA
Mailing Address - Zip Code:95595-9604
Mailing Address - Country:US
Mailing Address - Phone:707-923-1657
Mailing Address - Fax:
Practice Address - Street 1:HC 62 BOX 36
Practice Address - Street 2:
Practice Address - City:ZENIA
Practice Address - State:CA
Practice Address - Zip Code:95595-9604
Practice Address - Country:US
Practice Address - Phone:707-923-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM358176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife