Provider Demographics
NPI:1467633099
Name:CONKLE, AMANDA GAIL (RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:GAIL
Last Name:CONKLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:GAIL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:122 WINTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5408
Mailing Address - Country:US
Mailing Address - Phone:910-848-1713
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical