Provider Demographics
NPI:1265615694
Name:YOUNG, RAQUEL RAE (LPN)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:RAE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:BRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:10265 RIDENOUR RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9692
Mailing Address - Country:US
Mailing Address - Phone:740-246-4854
Mailing Address - Fax:
Practice Address - Street 1:10265 RIDENOUR RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9692
Practice Address - Country:US
Practice Address - Phone:740-246-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse