Provider Demographics
NPI:1801060256
Name:CONRAD, DENEISE HARRIS (RN, CPNP)
Entity type:Individual
Prefix:
First Name:DENEISE
Middle Name:HARRIS
Last Name:CONRAD
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:LEVA
Other - Middle Name:DENEISE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,CPNP
Mailing Address - Street 1:PO BOX 40159
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-871-4409
Mailing Address - Fax:210-524-9599
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-871-4409
Practice Address - Fax:210-524-9599
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237506363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics