Provider Demographics
NPI:1952702045
Name:YOUNG, JAMIE (RN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 LAKE AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1085
Mailing Address - Country:US
Mailing Address - Phone:262-721-6907
Mailing Address - Fax:
Practice Address - Street 1:2422 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6105
Practice Address - Country:US
Practice Address - Phone:262-721-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171795-30163W00000X, 163WA0400X, 163WC0400X, 163WC1500X, 163WC1600X, 163WD0400X, 163WE0003X, 163WG0600X, 163WH0200X, 163WH1000X, 163WP0000X, 163WR0400X, 163WS0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WW0000XNursing Service ProvidersRegistered NurseWound Care