Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 272670 | OR |
NPI | 1710954565 |
---|---|
Provider Name | Jeanne M Young |
First Address | Bend, OR 97701-2731 |
Second Address | Bend, OR 97701-2731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 22/08/2008 |