Provider Demographics
NPI:1639433154
Name:YOUNG, EBONY (RN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 CROFTON CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4221
Mailing Address - Country:US
Mailing Address - Phone:571-217-4648
Mailing Address - Fax:
Practice Address - Street 1:1114 CROFTON CT
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4221
Practice Address - Country:US
Practice Address - Phone:571-217-4648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15089600163W00000X
PARN636418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse