Provider Demographics
NPI:1003055294
Name:YOUNG, THERESA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:ME
Mailing Address - Zip Code:04438-3331
Mailing Address - Country:US
Mailing Address - Phone:207-525-4526
Mailing Address - Fax:
Practice Address - Street 1:360 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3979
Practice Address - Country:US
Practice Address - Phone:207-525-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER054148163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse