Provider Demographics
NPI:1265718142
Name:YOUNG, CAITLIN MARIE (CNM, MSN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:WAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7724 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:720-273-8502
Mailing Address - Fax:
Practice Address - Street 1:968 GRAND AVE.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105
Practice Address - Country:US
Practice Address - Phone:651-895-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCNM-170014176B00000X
MNCNM176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife