Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | F430472-1 | NY |
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP016507 | PA |
NPI | 1013245661 |
---|---|
Provider Name | Bonnie Tong Young |
First Address | Dalton, PA 18414-9622 |
Second Address | Wilkes Barre, PA 18711-0027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2009 |
Last Update Date | 30/08/2020 |