Provider Demographics
NPI:1558914747
Name:YOUNG, ROWENA DUMOT (CNA)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:DUMOT
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5452
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-9165
Mailing Address - Country:US
Mailing Address - Phone:808-744-0845
Mailing Address - Fax:833-249-6216
Practice Address - Street 1:87-162 MANUOIOI PL
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3232
Practice Address - Country:US
Practice Address - Phone:808-744-0845
Practice Address - Fax:833-249-6216
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-170044376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator