Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | LL29003 | SC |
N | 207V00000X | Obstetrician & Gynecologist | ME107193 | FL |
Y | 207VX0000X | Obstetrician | 39662 | IA |
NPI | 1073693719 |
---|---|
Provider Name | Dr. Jona Marie Conklin |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-3034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 31/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002380900 | (05) | FL |