Provider Demographics
NPI:1497874069
Name:YOUNG-METTILLE, SALLY JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JEAN
Last Name:YOUNG-METTILLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:JEAN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1587 MEDARY LN
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8407
Mailing Address - Country:US
Mailing Address - Phone:608-783-6231
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST
Practice Address - Street 2:STE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:608-785-5892
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health