Provider Demographics
NPI:1639302656
Name:YOUNGMAN, DANIEL EDWARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWARD
Last Name:YOUNGMAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:APT 4
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-1132
Mailing Address - Country:US
Mailing Address - Phone:585-447-0030
Mailing Address - Fax:
Practice Address - Street 1:9 NORTH STATE ST.
Practice Address - Street 2:APT . 4
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517
Practice Address - Country:US
Practice Address - Phone:585-447-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262884164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse