Provider Demographics
NPI:1275017774
Name:YOUNG, MELISSA E (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S 120TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1687
Mailing Address - Country:US
Mailing Address - Phone:531-299-8581
Mailing Address - Fax:531-299-2298
Practice Address - Street 1:1616 S 120TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1687
Practice Address - Country:US
Practice Address - Phone:531-299-8581
Practice Address - Fax:531-299-2298
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35565163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35565Medicaid