Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | R172502 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R172502 | MD |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R172502 | MD |
NPI | 1053602763 |
---|---|
Provider Name | Mrs. Nicole Conkling |
First Address | Lutherville, MD 21093-7026 |
Second Address | Timonium, MD 21093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 13/11/2019 |