Provider Demographics
NPI:1265423784
Name:YOUNG, NANCY MARGARET (LISW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARGARET
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:88 MDOS/SGOWS
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5336
Mailing Address - Country:US
Mailing Address - Phone:937-257-3112
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:88 MDOS/SGOWS
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5336
Practice Address - Country:US
Practice Address - Phone:937-257-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008455171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider