Provider Information for 1073242467
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MARSHA JO CONKLIN
Sex: Female
NPI: 1073242467
Last Updated: 2022-06-09
Certification Date: 2022-06-09
Certification Date: 2022-06-09
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073242467 | ||||||||
| Enumeration Date | 2022-06-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1023 SPRING LILY PT APT 101 CASSELBERRY, FL 32707-5470 United States Phone: 407-335-6755 | Fax: | ||||||||
| Primary Practice Address | 1023 SPRING LILY PT APT 101 CASSELBERRY, FL 32707-5470 United States Phone: 407-335-6755 | Fax: | ||||||||
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