Provider Demographics
NPI:1669217246
Name:YOUNG, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
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 1:750 N STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:OH
Mailing Address - Zip Code:44867-9786
Mailing Address - Country:US
Mailing Address - Phone:615-752-7296
Mailing Address - Fax:
Practice Address - Street 1:750 N STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:OH
Practice Address - Zip Code:44867-9786
Practice Address - Country:US
Practice Address - Phone:615-752-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver