Provider Demographics
NPI:1972754828
Name:YOUNG, CAROLYN J (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 SAN LEANDRO BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1598
Mailing Address - Country:US
Mailing Address - Phone:510-618-1901
Mailing Address - Fax:510-667-3140
Practice Address - Street 1:1000 SAN LEANDRO BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1598
Practice Address - Country:US
Practice Address - Phone:510-618-1901
Practice Address - Fax:510-667-3140
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404358163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management