Provider Demographics
NPI:1346723756
Name:YOUNG, DACIA LORRAINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DACIA
Middle Name:LORRAINE
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 1:3101 POLZER DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4133
Mailing Address - Country:US
Mailing Address - Phone:715-892-5569
Mailing Address - Fax:
Practice Address - Street 1:5120 STETTIN DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3824
Practice Address - Country:US
Practice Address - Phone:715-551-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2333-08163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant