Provider Demographics
NPI:1962510966
Name:CONKEY, MARTHA L (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:CONKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 EXPLORER RD SW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615
Mailing Address - Country:US
Mailing Address - Phone:330-407-4948
Mailing Address - Fax:
Practice Address - Street 1:1445 HARRISON AVE NW
Practice Address - Street 2:SUITE 302
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2620
Practice Address - Country:US
Practice Address - Phone:330-452-9900
Practice Address - Fax:330-452-9945
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09488NP363LW0102X
OHAPRN.CNP09488363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP29921Medicare PIN