Provider Demographics
NPI:1740712686
Name:BOCOOK-YOUNGMAN, NANCY LOU (LPN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LOU
Last Name:BOCOOK-YOUNGMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LOU
Other - Last Name:YOUNGMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:304-550-3743
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:2600 SIXTH ST SW FL 6
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-830-3393
Practice Address - Fax:234-521-7091
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.079719.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256177Medicaid