Provider Demographics
NPI:1639124076
Name:YOUNG, MELISSA M (RN MS CPNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN MS CPNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MICHELLE
Other - Last Name:OZUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3914
Mailing Address - Fax:520-670-3714
Practice Address - Street 1:839 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2819
Practice Address - Country:US
Practice Address - Phone:520-670-3914
Practice Address - Fax:520-670-3714
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 107098163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ025395Medicaid