Provider Demographics
NPI:1447704705
Name:CONKLIN, SUSAN MCKENNA (DNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCKENNA
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ALANNA
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 RESEARCH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6228
Mailing Address - Country:US
Mailing Address - Phone:203-210-6340
Mailing Address - Fax:
Practice Address - Street 1:7 GERMANTOWN RD STE 2B
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5000
Practice Address - Country:US
Practice Address - Phone:475-206-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.006624363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily