Provider Demographics
NPI:1073554119
Name:YOUNG, DONELLA S (MD)
Entity Type:Individual
Prefix:
First Name:DONELLA
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9730
Practice Address - Country:US
Practice Address - Phone:509-725-7501
Practice Address - Fax:509-725-7504
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154353Medicaid
WACJ6525OtherMEDICARE RAILROAD
WA080187185OtherMEDICARE RAILROAD
WA7101132Medicaid
WA7117450Medicaid
WA154736OtherDEPT. OF L & I
WA154736OtherDEPT. OF L & I
WACJ6525OtherMEDICARE RAILROAD
F72987Medicare UPIN
WA8154353Medicaid
WA508528Medicare Oscar/Certification
WA508529Medicare Oscar/Certification