Provider Demographics
NPI:1831523216
Name:YOUNG, MICHAEL DEAN (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NE
Mailing Address - Zip Code:68461-9754
Mailing Address - Country:US
Mailing Address - Phone:402-770-9931
Mailing Address - Fax:866-782-0103
Practice Address - Street 1:245 S 84TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2680
Practice Address - Country:US
Practice Address - Phone:402-219-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse