Provider Demographics
NPI:1013153220
Name:YOUNG, ADELE E (PNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PNP, PHD
Other - Prefix:MISS
Other - First Name:ADELE
Other - Middle Name:
Other - Last Name:EISSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP, PHD
Mailing Address - Street 1:4379 RIDGEWOOD CENTER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8323
Mailing Address - Country:US
Mailing Address - Phone:703-680-7950
Mailing Address - Fax:703-680-7953
Practice Address - Street 1:4379 RIDGEWOOD CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8323
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024146467363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics