Provider Demographics
NPI:1578653440
Name:YOUNG, JOLENE GAIL (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:GAIL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:GAIL
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2311 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3822
Mailing Address - Country:US
Mailing Address - Phone:814-943-0638
Mailing Address - Fax:
Practice Address - Street 1:1402 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-940-2000
Practice Address - Fax:814-569-1878
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN328812L163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management