Provider Demographics
NPI:1417256751
Name:YOUNG, MELODY ANN (LVN)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 BIG OAKS DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-8209
Mailing Address - Country:US
Mailing Address - Phone:530-822-9228
Mailing Address - Fax:
Practice Address - Street 1:1077 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-3002
Practice Address - Country:US
Practice Address - Phone:530-674-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 104567164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse