Provider Demographics
NPI:1013294016
Name:YOUNG, WENDELL L (RN)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1833
Mailing Address - Country:US
Mailing Address - Phone:567-377-6014
Mailing Address - Fax:
Practice Address - Street 1:4242 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1833
Practice Address - Country:US
Practice Address - Phone:567-377-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH370014163W00000X
MI4704286067163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse