Provider Demographics
NPI:1346032976
Name:CONRAD, DOROTHY MARIE
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:WV
Mailing Address - Zip Code:26055-4054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:97 JAMES LN
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:WV
Practice Address - Zip Code:26055-4054
Practice Address - Country:US
Practice Address - Phone:814-367-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide