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General NPI Number Information
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NPI Number | 1962510966
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Entity Type | Individual
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Provider Name | MARTHA L CONKEY NP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 1445 HARRISON AVE NW SUITE 302
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City | CANTON
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State | OH
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Zip | 44708-2620
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Country | US
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Telephone | 330-452-9900
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Fax | 330-452-9945
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Provider Business Mailing Address
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Address Line | 3065 EXPLORER RD SW
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City | CARROLLTON
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State | OH
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Zip | 44615
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Country | US
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Telephone | 330-407-4948
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | COA.09488NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN.CNP09488
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License Number State | OH
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