Provider Demographics
NPI:1639235211
Name:YOUNG, CHARLOTTE KAREN (RN, APN,BC)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:KAREN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN, APN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KILLDEER DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3031
Mailing Address - Country:US
Mailing Address - Phone:908-852-7730
Mailing Address - Fax:
Practice Address - Street 1:651 WILLOW GROVE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1799
Practice Address - Country:US
Practice Address - Phone:908-441-1127
Practice Address - Fax:908-441-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO4523900163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034608Medicare ID - Type Unspecified
NJS96777Medicare UPIN