Provider Demographics
NPI:1073103545
Name:YOUNG, BRISHA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:BRISHA
Middle Name:NICOLE
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 1:1 WICKLOW CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7330
Mailing Address - Country:US
Mailing Address - Phone:678-491-7477
Mailing Address - Fax:
Practice Address - Street 1:1 WICKLOW CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7330
Practice Address - Country:US
Practice Address - Phone:678-491-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA219040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty