Provider Demographics
NPI:1518080696
Name:YOUNG, HEIDI LANE (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LANE
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 1:901 S ERVAY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6419
Mailing Address - Country:US
Mailing Address - Phone:214-939-3933
Mailing Address - Fax:914-653-1962
Practice Address - Street 1:901 S ERVAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6419
Practice Address - Country:US
Practice Address - Phone:214-939-3933
Practice Address - Fax:914-653-1962
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX706469163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult