Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | M-14875 | ID |
Y | 207VG0400X | Gynecologist | M-14875 | ID |
NPI | 1629310347 |
---|---|
Provider Name | Dr. Laura Danielle Young |
First Address | Post Falls, ID 83854-5326 |
Second Address | Post Falls, ID 83854-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1629310347 | (05) | ID |
2140750 | (05) | WA |