Provider Demographics
NPI:1902892839
Name:CONRAD, JOSEPH CARLOS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CARLOS
Last Name:CONRAD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4174
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4174
Mailing Address - Country:US
Mailing Address - Phone:336-683-5284
Mailing Address - Fax:336-683-5279
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-683-5284
Practice Address - Fax:336-683-5279
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC143454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051390Medicaid
NC2600950CMedicare PIN