Provider Demographics
NPI:1275619132
Name:CONKLIN, DONNA (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:CANAVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNFA
Mailing Address - Street 1:1771 TOMMY AARON
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-822-1988
Mailing Address - Fax:915-821-9581
Practice Address - Street 1:1771 TOMMY AARON
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-822-1988
Practice Address - Fax:915-821-9581
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567401163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50289OtherPRESBYTERIAN SALUD PROVID
TX0004HTOtherBC/BS PROVIDER NUMBER