Provider Demographics
NPI:1508050683
Name:CONKLIN, ANGELA K (APN/CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W EXCHANGE ST
Mailing Address - Street 2:PO BOX 268
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4008
Mailing Address - Country:US
Mailing Address - Phone:815-599-7958
Mailing Address - Fax:
Practice Address - Street 1:1120 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1461
Practice Address - Country:US
Practice Address - Phone:815-244-4181
Practice Address - Fax:815-244-4185
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-006719OtherAPN LICENSE