Provider Demographics
NPI:1831458819
Name:REID-YOUNG, AVIS MULVINA
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:MULVINA
Last Name:REID-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 1:143 KENNEDY ST NW
Mailing Address - Street 2:#5
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5228
Mailing Address - Country:US
Mailing Address - Phone:202-450-4122
Mailing Address - Fax:202-450-4123
Practice Address - Street 1:143 KENNEDY ST NW
Practice Address - Street 2:#5
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5228
Practice Address - Country:US
Practice Address - Phone:202-450-4122
Practice Address - Fax:202-450-4123
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide