Provider Demographics
NPI:1821695339
Name:YOUNG, BREANNA ALISIA (PA-C)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:ALISIA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1681
Mailing Address - Country:US
Mailing Address - Phone:775-445-5181
Mailing Address - Fax:
Practice Address - Street 1:2874 N CARSON ST STE 120
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1681
Practice Address - Country:US
Practice Address - Phone:307-259-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant