Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP-1256A | ID |
NPI | 1013258268 |
---|---|
Provider Name | Christine A Young |
First Address | Coeur D Alene, ID 83814 |
Second Address | Wenatchee, WA 98801-3370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2013 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2031831 | (05) | WA |
NP-1256A | ID LICENSE (01) | ID |