Provider Demographics
NPI:1205817202
Name:YOUNG, CAROL JEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790058
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0058
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1620
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-718-9800
Practice Address - Fax:301-986-1672
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085163367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS417 0010OtherBCBS - CAREFIRST
MD430072671OtherRR MEDICARE
MDKBC1CHOtherBCBS - CAREFIRST
MD076931200Medicaid
MD00B123C47Medicare ID - Type Unspecified