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Individual

MS. MARY KATHERINE CONKLEN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
APN

Contact information

Practice address
710 N 8TH ST, SPRINGFIELD, IL 62702-6324
(217) 525-1064
(217) 525-1651
Mailing address
710 N 8TH ST, SPRINGFIELD, IL 62702-6324
(217) 525-1064
(217) 525-1651

Taxonomy

Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00088386
RAILROAD MEDICARE
IL
Enumeration date
03/09/2006
Last updated
07/08/2007
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