Provider Demographics
NPI:1558962449
Name:YOUNG, ANDRE PIERRE (RN)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:PIERRE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 ELMSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4765
Mailing Address - Country:US
Mailing Address - Phone:804-338-5932
Mailing Address - Fax:
Practice Address - Street 1:1124 ELMSHADOW DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-4765
Practice Address - Country:US
Practice Address - Phone:804-338-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001185136163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management