Provider Demographics
NPI:1043663404
Name:YOUNG, ANNA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-0817
Mailing Address - Country:US
Mailing Address - Phone:989-539-2141
Mailing Address - Fax:989-539-2143
Practice Address - Street 1:789 N CLARE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-8250
Practice Address - Country:US
Practice Address - Phone:989-539-2141
Practice Address - Fax:989-539-2143
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704322974163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health