Provider Demographics
NPI:1437137130
Name:YOUNG, LINDA SUE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 GABRIEL DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7852
Practice Address - Country:US
Practice Address - Phone:207-626-3426
Practice Address - Fax:207-621-8393
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026922363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010317679OtherTAX ID#
ME2507855OtherAETNA
ME105650102Medicaid