Provider Demographics
NPI:1700335387
Name:YOUNG, EARLEEN
Entity Type:Individual
Prefix:
First Name:EARLEEN
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 1:17 SYDNEY LOOP
Mailing Address - Street 2:# 2
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-4488
Mailing Address - Country:US
Mailing Address - Phone:770-875-4034
Mailing Address - Fax:
Practice Address - Street 1:17 SYDNEY LOOP
Practice Address - Street 2:# 2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-4488
Practice Address - Country:US
Practice Address - Phone:770-875-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide