Provider Demographics
NPI:1184631301
Name:CONKLIN, JOAN LORETTA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LORETTA
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 CH128
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-0176
Mailing Address - Country:US
Mailing Address - Phone:419-927-5193
Mailing Address - Fax:419-927-5593
Practice Address - Street 1:6829 CH128
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-0176
Practice Address - Country:US
Practice Address - Phone:419-927-5193
Practice Address - Fax:419-927-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN094712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse