Provider Demographics
NPI:1992215289
Name:YOUNG, DEBRA RENA (LPN,CCMA, NA)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RENA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN,CCMA, NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 W DEARBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3842
Mailing Address - Country:US
Mailing Address - Phone:414-839-1363
Mailing Address - Fax:414-800-4213
Practice Address - Street 1:12234 W DEARBOURN AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3842
Practice Address - Country:US
Practice Address - Phone:414-839-1363
Practice Address - Fax:414-800-4213
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043133699164W00000X
MN824688164W00000X
WI325641164X00000X
374U00000X, 3747P1801X
WI187357376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide