Healthcare Provider Details

I. General information

NPI: 1962510966
Provider Name (Legal Business Name): MARTHA L CONKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 HARRISON AVE NW SUITE 302
CANTON OH
44708-2620
US

IV. Provider business mailing address

3065 EXPLORER RD SW
CARROLLTON OH
44615
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-9900
  • Fax: 330-452-9945
Mailing address:
  • Phone: 330-407-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.09488NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP09488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: