Provider Demographics
NPI:1164016580
Name:YOUNG, LANIE ORRINE (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:LANIE
Middle Name:ORRINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3018
Mailing Address - Country:US
Mailing Address - Phone:907-317-8512
Mailing Address - Fax:
Practice Address - Street 1:2200 ROOSEVELT DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517
Practice Address - Country:US
Practice Address - Phone:907-317-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376G00000XNursing Service Related ProvidersNursing Home Administrator