Provider Demographics
NPI:1720052343
Name:VEGLIA YOUNG, CAROLYN MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARIE
Last Name:VEGLIA YOUNG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2525 CHICAGO AVENUE SOUTH
Mailing Address - Street 2:CHILDREN'S HOSPITALS AND CLINIC OF MINNESOTA
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-813-6117
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:CHILDREN'S HOSPITALS AND CLINIC OF MINNESOTA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1428513163WP0200X
MNR 142851-3363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN901453500Medicaid
MN901453500Medicaid
Q01005Medicare UPIN