Provider Demographics
NPI:1083747448
Name:YOUNG, JOANN M (CDN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2227
Mailing Address - Country:US
Mailing Address - Phone:607-737-0939
Mailing Address - Fax:
Practice Address - Street 1:721 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2227
Practice Address - Country:US
Practice Address - Phone:607-737-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004725-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist