Provider Demographics
NPI:1578326955
Name:YOUNG, HEATHER MARIE (NC60001082)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NC60001082
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 WALES LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-8025
Mailing Address - Country:US
Mailing Address - Phone:360-972-5989
Mailing Address - Fax:
Practice Address - Street 1:3704 WALES LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-8025
Practice Address - Country:US
Practice Address - Phone:360-972-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3747A0650X3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider