Individual
MS. MARY JACK CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1425 S MAIN ST, MOB 3RD FLOOR SURGERY CLINIC, WALNUT CREEK, CA 94596-5318
(925) 295-4659
Mailing address
1425 S MAIN ST, MOB 3RD FLOOR SURGERY CLINIC, WALNUT CREEK, CA 94596-5318
(925) 295-4110
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
302434
CA
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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