Individual
LORRAINE CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
(260) 435-7334
(260) 435-7748
Mailing address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
(260) 435-7334
(260) 435-7748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000299A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
668020U
MEDICARE ID
IN
Enumeration date
06/04/2006
Last updated
09/16/2020
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