Provider Demographics
NPI:1407074628
Name:YOUNG, DARLENE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:LOUISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 OLD WARSAW RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IL
Mailing Address - Zip Code:62379-3001
Mailing Address - Country:US
Mailing Address - Phone:217-256-3252
Mailing Address - Fax:
Practice Address - Street 1:583 OLD WARSAW RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IL
Practice Address - Zip Code:62379-3001
Practice Address - Country:US
Practice Address - Phone:217-256-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8672219347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle