Provider Demographics
NPI:1265686703
Name:CONKLIN, HEIDI ANN (CNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 MONCLOVA RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1864
Mailing Address - Country:US
Mailing Address - Phone:419-578-7555
Mailing Address - Fax:419-539-6336
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:SUITE 320
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1864
Practice Address - Country:US
Practice Address - Phone:419-578-7555
Practice Address - Fax:419-539-6336
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429241Medicaid
OH2940509Medicaid
OH2429241Medicaid
OH$$$$$$$$$00OtherBWC