Provider Demographics
NPI:1457639726
Name:YOUNG II, LARRY DALE (CRNA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DALE
Last Name:YOUNG II
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2510
Mailing Address - Country:US
Mailing Address - Phone:605-353-6565
Mailing Address - Fax:605-353-6300
Practice Address - Street 1:172 4TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2510
Practice Address - Country:US
Practice Address - Phone:605-353-6200
Practice Address - Fax:605-353-6300
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL087548OtherANCC CERTIFICATION NUMBER