Provider Demographics
NPI:1336823582
Name:YOUNG, VIRGINIA SUE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 EMMA RD
Mailing Address - Street 2:
Mailing Address - City:KENNA
Mailing Address - State:WV
Mailing Address - Zip Code:25248-7653
Mailing Address - Country:US
Mailing Address - Phone:304-546-6245
Mailing Address - Fax:
Practice Address - Street 1:2311 EMMA RD
Practice Address - Street 2:
Practice Address - City:KENNA
Practice Address - State:WV
Practice Address - Zip Code:25248-7653
Practice Address - Country:US
Practice Address - Phone:304-546-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant