Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 038425-23-03 | NH |
NPI | 1013014323 |
---|---|
Provider Name | Melanie A. Young |
First Address | Concord, NH 03301 |
Second Address | Boscawen, NH 03303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30008012 | (05) | NH |
S59792 | (02) | NH |