Provider Demographics
NPI:1508207739
Name:YOUNGER, PATRICE NORENE (STNA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:NORENE
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22085 LIBBY RD
Mailing Address - Street 2:APT# 102A
Mailing Address - City:BEDFORD HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:216-205-0364
Mailing Address - Fax:
Practice Address - Street 1:22085 LIBBY RD
Practice Address - Street 2:APT# 102A
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-6824
Practice Address - Country:US
Practice Address - Phone:216-205-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401545560713374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401545560713OtherSTNA