Individual
AUTUMN LEA CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
289 NORTH AVE, WASHINGTON, PA 15301-3512
(724) 223-7801
Mailing address
4297 PROSPERITY PIKE, PROSPERITY, PA 15329-1254
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
RN626758
PA
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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