Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | FF29 | MN |
NPI | 1043311210 |
---|---|
Provider Name | Heather Joan Conrad |
First Address | Minneapolis, MN 55455-0357 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 14/08/2007 |