Provider Demographics
NPI:1710382858
Name:YOUNG, SUGAR VINNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUGAR
Middle Name:VINNETTE
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:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-2198
Mailing Address - Country:US
Mailing Address - Phone:928-697-3878
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 163
Practice Address - Street 2:KAYENTA HEALTH CENTER BLDG KA-2010
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN107535163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPUPPYLOVE27Medicare PIN