1831044320 NPI number — MRS. AUTUMN MARIE CONKLIN BSN, RN

Table of content: MRS. AUTUMN MARIE CONKLIN BSN, RN (NPI 1831044320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831044320 NPI number — MRS. AUTUMN MARIE CONKLIN BSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONKLIN
Provider First Name:
AUTUMN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831044320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 LAKE ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMIRA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14901-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-742-0369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 LAKE ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14901-1255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-742-0369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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