Provider Demographics
NPI:1679927321
Name:CONKLIN, MARK (EMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 CANARY CIR
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-6512
Mailing Address - Country:US
Mailing Address - Phone:775-770-6237
Mailing Address - Fax:775-980-6137
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4460
Practice Address - Country:US
Practice Address - Phone:775-770-6237
Practice Address - Fax:775-770-6235
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11233146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic