Provider Demographics
NPI:1235521477
Name:YOUNG, REGINA MARY (ADULT HEALTH NP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ADULT HEALTH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4303
Mailing Address - Country:US
Mailing Address - Phone:253-682-1710
Mailing Address - Fax:
Practice Address - Street 1:305 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1652
Practice Address - Country:US
Practice Address - Phone:631-218-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30307087363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health