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General NPI Number Information
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NPI Number | 1538983481
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Entity Type | Individual
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Provider Name | ALLISON LEIGH CONKLIN
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 19 WOODLAND ST
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City | HARTFORD
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State | CT
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Zip | 06105-2372
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Country | US
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Telephone | 860-525-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 38 COOPER LN
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-1313
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Country | US
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Telephone | 860-305-1202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 14099
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License Number State | CT
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