Provider Demographics
NPI:1811412943
Name:YOUNG, ROLANDA GAYLE
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:GAYLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 PRESIDENT DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2947
Mailing Address - Country:US
Mailing Address - Phone:225-421-6772
Mailing Address - Fax:225-308-8909
Practice Address - Street 1:9800 AIRLINE HWY
Practice Address - Street 2:STE 231
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8171
Practice Address - Country:US
Practice Address - Phone:225-421-6772
Practice Address - Fax:225-308-8909
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education