Provider Demographics
NPI:1407215221
Name:YOUNG, NOREEN ELAINE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:ELAINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 S BROOK ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2067
Mailing Address - Country:US
Mailing Address - Phone:515-979-6887
Mailing Address - Fax:
Practice Address - Street 1:1467 SCOTT VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7795
Practice Address - Country:US
Practice Address - Phone:502-287-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2501133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered