Provider Demographics
NPI:1902184773
Name:YOUNG, SUSANNAH V (NP)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:V
Last Name:YOUNG
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 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7027
Mailing Address - Country:US
Mailing Address - Phone:207-795-0111
Mailing Address - Fax:207-753-7201
Practice Address - Street 1:2577 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5919
Practice Address - Country:US
Practice Address - Phone:970-247-8382
Practice Address - Fax:970-259-4403
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP111056363L00000X
COC-APN.0003259-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner