Provider Demographics
NPI:1285689042
Name:CONKLE, ROSETTE MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ROSETTE
Middle Name:MARIE
Last Name:CONKLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-270-7500
Mailing Address - Fax:717-228-1642
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6111
Practice Address - Country:US
Practice Address - Phone:717-270-7500
Practice Address - Fax:717-228-1642
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN341972L367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001923850Medicaid
48502OtherAANA
PA50091141OtherCAPITAL BLUECROSS
PAG920-0143/85XWCUOtherCAREFIRST
PARN341972LOtherLICENSE
PA050514OtherMEDICARE GROUP #
PA50091141OtherCAPITAL BLUECROSS
48502OtherAANA
48502OtherAANA