Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01071294A | IN |
Y | 2084N0402X | Child Neurologist | 01071294A | IN |
NPI | 1265667901 |
---|---|
Provider Name | Susan C Conrad |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-1972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 08/01/2021 |