Basic Information
| Provider Information | |||||||||
| NPI: | 1831275528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONRAD | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 S WASHINGTON ST | ||||||||
| Address2: | HOSPITALIST GROUP | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108221000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 219 SOUTH WASHINGTON ST | ||||||||
| Address2: | HOSPITALIST GROUP | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108221000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN3166402 | FL | N | Nursing Service Providers | Registered Nurse | 363LA2100X | ARNP3166402 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 810945100 | 05 | FL | MEDICAID |