Provider Demographics
NPI:1477884658
Name:YOUNG, WAKISHA RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:WAKISHA
Middle Name:RENEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WESLEYAN DR
Mailing Address - Street 2:APT 2901
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8807
Mailing Address - Country:US
Mailing Address - Phone:478-251-8101
Mailing Address - Fax:
Practice Address - Street 1:1900 WESLEYAN DR
Practice Address - Street 2:APT 2901
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8807
Practice Address - Country:US
Practice Address - Phone:478-251-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse