Provider Demographics
NPI:1144286733
Name:CONRAD, SUSANNE MARGARET (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARGARET
Last Name:CONRAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 WINTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2300
Mailing Address - Country:US
Mailing Address - Phone:330-262-0091
Mailing Address - Fax:330-262-0365
Practice Address - Street 1:546 WINTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2300
Practice Address - Country:US
Practice Address - Phone:330-262-0091
Practice Address - Fax:330-262-0365
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000384188OtherANTHEM
OH2623012Medicaid
OH000000384188OtherANTHEM