Individual
NICOLE MARIE CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
707 SW WASHINGTON ST STE 700, PORTLAND, OR 97205
(503) 299-9906
(503) 225-9002
Mailing address
PO BOX 35147, #1801, SEATTLE, WA 98124-5147
(503) 299-9906
(503) 225-9002
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2016-01046
NC
207L00000X
Anesthesiology Physician
Primary
MD184031
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500653884
—
OR
Enumeration date
04/19/2011
Last updated
10/10/2018
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