Provider Demographics
NPI:1295730984
Name:YOUNG, LYNNA R (FNP-C)
Entity type:Individual
Prefix:
First Name:LYNNA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 E JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2462
Mailing Address - Country:US
Mailing Address - Phone:760-416-0504
Mailing Address - Fax:
Practice Address - Street 1:55585 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2505
Practice Address - Country:US
Practice Address - Phone:760-228-3366
Practice Address - Fax:760-228-3369
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10058OtherLICENSE, FNP-C
CA431345OtherLICENSE, RN
CA10058OtherLICENSE, FNP-C