Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F38109 | NY |
NPI | 1013219864 |
---|---|
Provider Name | Mrs. Rachel L Young |
First Address | Syracuse, NY 13205-2552 |
Second Address | Syracuse, NY 13205-2552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2010 |
Last Update Date | 30/11/2010 |