Provider Demographics
NPI:1033138441
Name:YOUNG, ANJANA MENON (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ANJANA
Middle Name:MENON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9600
Mailing Address - Country:US
Mailing Address - Phone:704-485-4581
Mailing Address - Fax:
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:980-323-4590
Practice Address - Fax:980-323-8269
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC161797367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053083Medicaid
NC8053083Medicaid
NCQ52759F546Medicare PIN