Provider Demographics
NPI:1831475714
Name:YOUNGER, ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HERA VILLE
Mailing Address - Street 2:6574 HANNAMDONG
Mailing Address - City:YONGSANGU
Mailing Address - State:SEOUL
Mailing Address - Zip Code:140887
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 HERA VILLE
Practice Address - Street 2:6574 HANNAMDONG
Practice Address - City:YONGSANGU
Practice Address - State:SEOUL
Practice Address - Zip Code:140887
Practice Address - Country:KR
Practice Address - Phone:0105-103-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN284350363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health