Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 176B00000X | Midwife | MW276 | FL |
NPI | 1023335023 |
---|---|
Provider Name | Charlie Rae Young |
First Address | Sydney, FL 33587-0265 |
Second Address | Tampa, FL 33602-1522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 26/05/2021 |