Provider Demographics
NPI:1912208117
Name:YOUNG, OLIVIA S (CNM)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:175 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2099
Practice Address - Country:US
Practice Address - Phone:609-914-6198
Practice Address - Fax:856-246-9565
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2020-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN618861163W00000X
NJ25ME00068200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse