Provider Demographics
NPI:1407163454
Name:YOUNG, TREDENA NICOLE (NMD)
Entity Type:Individual
Prefix:DR
First Name:TREDENA
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 FAIR OAKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7051
Mailing Address - Country:US
Mailing Address - Phone:916-265-9990
Mailing Address - Fax:855-952-1992
Practice Address - Street 1:9801 FAIR OAKS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7051
Practice Address - Country:US
Practice Address - Phone:916-265-9990
Practice Address - Fax:833-643-1223
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND564175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath