Provider Demographics
NPI:1740553916
Name:YOUNG, MICHELE ANN-MARIE (LPN-LICENSE PRACTICA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN-MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN-LICENSE PRACTICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-469-9202
Mailing Address - Fax:
Practice Address - Street 1:524 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTER
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-469-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302009-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse