Provider Demographics
NPI:1679630289
Name:YOUNG, RUTH ELLEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ELLEN
Last Name:YOUNG
Suffix:
Gender:F
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:RR 1 BOX 146
Mailing Address - Street 2:
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-9707
Mailing Address - Country:US
Mailing Address - Phone:814-697-7188
Mailing Address - Fax:716-353-4796
Practice Address - Street 1:RR 1 BOX 146
Practice Address - Street 2:
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748-9707
Practice Address - Country:US
Practice Address - Phone:814-697-7188
Practice Address - Fax:716-353-4796
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219906-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse