Provider Demographics
NPI:1669998035
Name:CONKLIN, ELISHA MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:MARIE
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 TENEFLY RD
Mailing Address - Street 2:
Mailing Address - City:CASTILE
Mailing Address - State:NY
Mailing Address - Zip Code:14427-9733
Mailing Address - Country:US
Mailing Address - Phone:585-689-9633
Mailing Address - Fax:
Practice Address - Street 1:6641 TENEFLY RD
Practice Address - Street 2:
Practice Address - City:CASTILE
Practice Address - State:NY
Practice Address - Zip Code:14427-9733
Practice Address - Country:US
Practice Address - Phone:585-689-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse