Provider Demographics
NPI:1720091333
Name:YOUNGMAN, ELAINE (CNS)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:PHETTEPLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3024 NEW BERN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1247
Mailing Address - Country:US
Mailing Address - Phone:919-350-8228
Mailing Address - Fax:919-350-7976
Practice Address - Street 1:3024 NEW BERN AVE
Practice Address - Street 2:SUITE 301 - INTERNAL MEDICINE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:919-350-7993
Practice Address - Fax:919-350-7988
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115567364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004015Medicaid
NC6004015Medicaid
NC2599157AMedicare ID - Type Unspecified