Provider Demographics
NPI:1235114588
Name:YOUNG, HARRIET L (CRNA)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HARRIET
Other - Middle Name:
Other - Last Name:DUPONT-HUDSON-CARMICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 18824
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-8824
Mailing Address - Country:US
Mailing Address - Phone:336-553-1659
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:336-553-1659
Practice Address - Fax:336-553-3994
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00352162OtherRR MEDICARE
GAP00352162Medicare PIN
GA43BBCRFMedicare PIN