Provider Demographics
NPI:1659024289
Name:YOUNG, ANTOINETTE ROSE
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:ROSE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANTOINETTE
Other - Middle Name:ROSE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SURGICAL TECH
Mailing Address - Street 1:3815 S URAVAN ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3422
Mailing Address - Country:US
Mailing Address - Phone:240-499-6608
Mailing Address - Fax:
Practice Address - Street 1:822 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3861
Practice Address - Country:US
Practice Address - Phone:719-486-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty