Provider Demographics
NPI:1083262224
Name:YOUNG, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5587 ORCHARD CV
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1292
Mailing Address - Country:US
Mailing Address - Phone:952-652-3959
Mailing Address - Fax:
Practice Address - Street 1:5587 ORCHARD CV
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-1292
Practice Address - Country:US
Practice Address - Phone:952-652-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390826374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide