Provider Demographics
NPI:1609364033
Name:YOUNG, ANDREW MARK KAVI (RN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK KAVI
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 1:65177 210TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MN
Mailing Address - Zip Code:55933-8843
Mailing Address - Country:US
Mailing Address - Phone:612-590-1171
Mailing Address - Fax:
Practice Address - Street 1:65177 210TH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MN
Practice Address - Zip Code:55933
Practice Address - Country:US
Practice Address - Phone:612-590-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198851-6163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health