Provider Demographics
NPI:1881770931
Name:CONRAD, LYNNETTE (PA-C)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MOUNTAIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3867
Mailing Address - Country:US
Mailing Address - Phone:775-882-1324
Mailing Address - Fax:775-882-3859
Practice Address - Street 1:1200 MOUNTAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-882-1324
Practice Address - Fax:775-882-3859
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV563363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS82453Medicare UPIN