Provider Demographics
NPI:1710220652
Name:CONRAD, MARIBETH (APRN-GNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:APRN-GNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROADWATER
Mailing Address - State:NE
Mailing Address - Zip Code:69125-9741
Mailing Address - Country:US
Mailing Address - Phone:308-763-1354
Mailing Address - Fax:
Practice Address - Street 1:1821 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2449
Practice Address - Country:US
Practice Address - Phone:308-672-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111470363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology