Provider Demographics
NPI:1972308724
Name:CONRADT-FRANCO, KONSTANZE EMMALINE (NP)
Entity type:Individual
Prefix:MRS
First Name:KONSTANZE
Middle Name:EMMALINE
Last Name:CONRADT-FRANCO
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2455
Mailing Address - Country:US
Mailing Address - Phone:707-495-2079
Mailing Address - Fax:
Practice Address - Street 1:5789 STATE FARM DR STE 110
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-6308
Practice Address - Country:US
Practice Address - Phone:707-615-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031220363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care