Provider Demographics
NPI:1710148267
Name:YOUNG, MARSHA L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 S JUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4961
Mailing Address - Country:US
Mailing Address - Phone:773-233-5233
Mailing Address - Fax:
Practice Address - Street 1:3650 MANSELL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3012
Practice Address - Country:US
Practice Address - Phone:180-056-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021117367500000X
ILAPN209001803367500000X
ILRN041139692367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered